Peters Femke P, Kara Mohammed A, Rosmolen Wilda D, ten Kate Fiebo J W, Krishnadath Kausilia K, van Lanschot J Jan B, Fockens Paul, Bergman Jacques J G H M
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Am J Gastroenterol. 2006 Jul;101(7):1449-57. doi: 10.1111/j.1572-0241.2006.00635.x.
Endoscopic therapy for early neoplasia in Barrett's esophagus (BE) is evolving rapidly. Aim of this study was to prospectively evaluate safety and efficacy of stepwise radical endoscopic resection (ER) of BE containing early neoplasia.
Patients with early neoplasia (i.e., high-grade intraepithelial neoplasia or early cancer) in BE < or = 5 cm, without signs of submucosal infiltration or lymph node/distant metastases, were included. Patients underwent resection sessions (cap technique after submucosal lifting) with intervals of 6 wk.
Between January 2003 and December 2004, 39 consecutive patients were included. Therapy was discontinued in two patients due to unrelated comorbidity. Complete eradication of early neoplasia was achieved in all 37 treated patients in a median number of three sessions. Complete removal of all Barrett's mucosa was achieved in 33 (89%) patients: 4 patients (all had undergone APC [argon plasma coagulation]) were found to have small isles of Barrett's mucosa underneath neosquamous mucosa. Complications occurred in two out of 88 (2%) ER procedures: one asymptomatic perforation, one delayed bleeding. Symptomatic stenosis occurred in 10 of 39 (26%) patients and was effectively treated by endoscopic bougienage. During a median follow-up of 11 months, no patients died and none had recurrence of neoplasia or Barrett's mucosa.
Stepwise radical ER is effective for selected patients with early neoplasia in BE; provides optimal histopathological diagnosis; and may reduce recurrence rate, since all mucosa at risk is effectively removed. Use of APC should be limited to prevent buried Barrett's mucosa. Methods for prevention of stenosis should be developed.
巴雷特食管（BE）早期瘤变的内镜治疗发展迅速。本研究旨在前瞻性评估含早期瘤变的BE逐步根治性内镜切除术（ER）的安全性和有效性。
纳入BE长度≤5 cm、无黏膜下浸润或淋巴结/远处转移迹象的早期瘤变（即高级别上皮内瘤变或早期癌）患者。患者接受切除手术（黏膜下抬举后采用套扎技术），间隔6周。
2003年1月至2004年12月，连续纳入39例患者。2例患者因无关合并症而停止治疗。37例接受治疗的患者均在中位3次手术中实现了早期瘤变的完全根除。33例（89%）患者实现了所有巴雷特黏膜的完全切除：4例患者（均接受过氩离子凝固术[APC]）在新鳞状黏膜下发现有小块巴雷特黏膜岛。88例ER手术中有2例（2%）发生并发症：1例无症状穿孔，1例延迟出血。39例患者中有10例（26%）出现症状性狭窄，经内镜扩张有效治疗。中位随访11个月期间，无患者死亡，无瘤变或巴雷特黏膜复发。
逐步根治性ER对选定的BE早期瘤变患者有效；提供最佳的组织病理学诊断；且可能降低复发率，因为所有有风险的黏膜均被有效切除。APC的使用应加以限制以防止隐匿性巴雷特黏膜。应开发预防狭窄的方法。
