Picasso Massimo, Blanchi Sabrina, Filiberti Rosangela, Di Muzio Marcello, Conio Massimo
Department of Gastroenterology, General Hospital, Corso Garibaldi 187, 18038 Sanremo Imperia, Italy.
Minim Invasive Ther Allied Technol. 2006;15(6):325-30. doi: 10.1080/13645700601037913.
Reports on the natural history of high-grade dysplasia (HGD) are sometimes contradictory, but suggest that 10-30% of patients with HGD in Barrett's esophagus (BE) will develop a demonstrable malignancy within five years of the initial diagnosis. Surgery has to be considered the best treatment for HGD or superficial carcinoma, but is contraindicated in patients with severe comorbidities. Non-surgical treatments such as intensive endoscopic surveillance, endoscopic ablative therapies, and endoscopic mucosal resection (EMR) have been proposed. EMR is a newly developed procedure promising to become a safe and reliable non-operative option for the endoscopic removal of HGD or early cancer within BE. It is important to assess the depth of invasion of the lesion and lymph node involvement before choosing EMR. This technique permits more effective staging of disease obtaining a large sample leading to a precise assessment of the depth of malignant invasion. Complications such as bleeding and perforation may occur, but can be treated endoscopically. Trials are needed to compare endoscopic therapy with surgical resection to establish clear criteria for EMR and ablative therapies.
关于高级别异型增生（HGD）自然史的报告有时相互矛盾，但表明巴雷特食管（BE）中10%-30%的HGD患者在初次诊断后的五年内会发展为可证实的恶性肿瘤。手术被认为是治疗HGD或浅表癌的最佳方法，但严重合并症患者禁忌手术。已提出非手术治疗方法，如强化内镜监测、内镜消融治疗和内镜黏膜切除术（EMR）。EMR是一种新开发的手术，有望成为内镜下切除BE内HGD或早期癌症的安全可靠的非手术选择。在选择EMR之前，评估病变的浸润深度和淋巴结受累情况很重要。该技术可以通过获取大样本更有效地进行疾病分期，从而精确评估恶性浸润深度。可能会出现出血和穿孔等并发症，但可以通过内镜治疗。需要进行试验来比较内镜治疗与手术切除，以建立EMR和消融治疗的明确标准。
