Wani Sachin, Sharma Prateek
Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Department of Veterans Affairs Medical Center, 4801 East Linwood Boulevard, Kansas City, MO 64128-2295, USA.
Best Pract Res Clin Gastroenterol. 2006;20(5):829-42. doi: 10.1016/j.bpg.2006.03.009.
Oesophageal adenocarcinoma is a rare cancer; however, it is the most rapidly increasing cancer in the western world. Barrett's oesophagus is the only recognised precursor and is associated with the majority of cases of adenocarcinoma. The role of screening and surveillance in patients with Barrett's oesophagus remains controversial. There is insufficient evidence to show that screening improves survival and is cost-effective. Indirect evidence suggests that patients diagnosed with cancer while undergoing surveillance endoscopy are diagnosed at an earlier stage and have an improved survival. The problems with current surveillance techniques include lack of data on natural history of Barrett's oesophagus, test invasiveness, costs, lack of standardisation and validation of biopsy and treatment protocols, and endoscopy intervals. The use of novel endoscopic techniques and biomarkers combined with better identification of high-risk groups could make screening and surveillance a cost-effective practice in the future.
食管腺癌是一种罕见的癌症；然而，它是西方世界中增长最为迅速的癌症。巴雷特食管是唯一被认可的癌前病变，且与大多数腺癌病例相关。对巴雷特食管患者进行筛查和监测的作用仍存在争议。没有足够的证据表明筛查能提高生存率且具有成本效益。间接证据表明，在接受监测性内镜检查时被诊断出癌症的患者，其癌症诊断时处于更早阶段，生存率也有所提高。当前监测技术存在的问题包括缺乏巴雷特食管自然病史的数据、检测的侵入性、成本、活检和治疗方案缺乏标准化和验证，以及内镜检查间隔时间。未来，使用新型内镜技术和生物标志物，结合对高危人群的更好识别，可能会使筛查和监测成为一种具有成本效益的做法。
