Johnston Mark H
Gastroenterology and Colon Cancer Center at the National Naval Medical Center, Bethesda, MD 20889-5600, USA.
Nat Clin Pract Gastroenterol Hepatol. 2005 Jul;2(7):323-30. doi: 10.1038/ncpgasthep0214.
New mucosal ablative techniques that can be used in the esophagus have emerged over the past two decades. These techniques have been developed primarily to treat the precursors of esophageal adenocarcinoma: dysplasia in Barrett's esophagus and early esophageal cancer. Although high-grade dysplasia and early stage cancer can be treated with esophagectomy, the inherent morbidity and mortality of esophageal adenocarcinoma and the morbidities, difficulties, costs and limitations of the current technology mean that there has been a significant increase in interest and research regarding alternative treatments such as ablative techniques. At this stage it is not clear which of the numerous endoscopic ablative techniques available-photodynamic therapy, laser therapy, multipolar electrocoagulation, argon plasma coagulation, endoscopic mucosal resection, radiofrequency ablation or cryotherapy-will emerge as superior. In addition, it has yet to be determined whether the risks associated with ablation therapy are less than the risk of Barrett's esophagus progressing to cancer. Whether ablation therapy eliminates or significantly reduces the risk of cancer, eliminates the need for surveillance endoscopy, or is cost-effective, also remains to be seen. Comparative trials that are now underway should help to answer these questions.
在过去二十年中，出现了可用于食管的新型黏膜消融技术。这些技术主要是为了治疗食管腺癌的前驱病变：巴雷特食管的异型增生和早期食管癌。尽管高级别异型增生和早期癌症可以通过食管切除术治疗，但食管腺癌固有的发病率和死亡率以及当前技术的并发症、难度、成本和局限性意味着，对于诸如消融技术等替代治疗的兴趣和研究显著增加。目前尚不清楚众多可用的内镜消融技术中——光动力疗法、激光疗法、多极电凝、氩等离子体凝固、内镜黏膜切除术、射频消融或冷冻疗法——哪种会脱颖而出。此外，消融治疗相关风险是否低于巴雷特食管进展为癌症的风险尚未确定。消融治疗是否能消除或显著降低癌症风险、消除内镜监测的必要性或具有成本效益，也有待观察。目前正在进行的对比试验应有助于回答这些问题。
