Lopes C V, Hela M, Pesenti C, Bories E, Caillol F, Monges G, Giovannini M
Endoscopy Unit, Paoli-Calmettes Institute, 232 Bd St-Marguerite, 13273, Marseille, Cedex 9, France.
Surg Endosc. 2007 May;21(5):820-4. doi: 10.1007/s00464-006-9187-3. Epub 2007 Feb 9.
Barrett's esophagus-related high-grade dysplasia or mucosal cancer can be treated by endoscopic mucosal resection (EMR), but the adjacent metaplastic epithelium remains at risk for developing further lesions. Our objective was to evaluate the results of the circumferential EMR in removing not only the neoplastic lesion but also the remaining Barrett's epithelium.
Forty-one consecutive patients (mean age: 66 years) with Barrett's esophagus were submitted to 63 EMR sessions in one single-referral endoscopic unit. All patients had high-grade dysplasia, and cancer was detected in 23 of these cases, most of them classified as T1N0 (20 patients) by endosonography. Mucosectomy after saline submucosal injection was performed for the neoplastic lesions and, if necessary, the residual Barrett's epithelium was removed by the same technique one month later.
A retrospective evaluation showed that, during a mean follow-up of 31.6 months, Barrett's epithelium was completely replaced by squamous epithelium in 31 (75.6%) cases. There were 10 complications, all of which were managed endoscopically: 8 cases of bleeding and two perforations occurred in 9 (14.3%) patients. One patient developed an esophageal stricture. Barrett's epithelium recurred in 10 (24.4%) patients and recurrent or metachronous early cancer was detected in 5 (12.2%), all but one of which were treated again by EMR; the fifth patient was referred to surgery. Argon plasma coagulation was used in 6 cases to treat Barrett's epithelium, and two patients received concomitant chemoradiotherapy as adjuvant therapy.
Circumferential EMR provides an effective endoscopic approach to the management of Barrett's esophagus-related high-grade dysplasia and mucosal cancer. Additional studies are necessary to evaluate the long-term results.
巴雷特食管相关的高级别异型增生或黏膜癌可通过内镜黏膜切除术（EMR）进行治疗，但相邻的化生上皮仍有发生进一步病变的风险。我们的目的是评估环形EMR在不仅切除肿瘤性病变而且切除剩余巴雷特上皮方面的效果。
在一个单一转诊的内镜科室，41例连续的巴雷特食管患者（平均年龄：66岁）接受了63次EMR治疗。所有患者均有高级别异型增生，其中23例检测到癌症，其中大多数经超声内镜检查分类为T1N0（20例患者）。对肿瘤性病变进行盐水黏膜下注射后行黏膜切除术，如有必要，1个月后采用相同技术切除残余的巴雷特上皮。
一项回顾性评估显示，在平均31.6个月的随访期间，31例（75.6%）患者的巴雷特上皮完全被鳞状上皮取代。发生了10例并发症，均通过内镜处理：9例（14.3%）患者发生8例出血和2例穿孔。1例患者出现食管狭窄。10例（24.4%）患者巴雷特上皮复发，5例（12.2%）检测到复发或异时性早期癌，除1例患者外，其余均再次接受EMR治疗；第5例患者转诊至外科手术。6例患者使用氩离子凝固术治疗巴雷特上皮，2例患者接受同步放化疗作为辅助治疗。
环形EMR为巴雷特食管相关的高级别异型增生和黏膜癌的管理提供了一种有效的内镜治疗方法。需要进一步研究以评估长期结果。
