Pouw R E, Peters F P, Sempoux C, Piessevaux H, Deprez P H
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Endoscopy. 2008 Nov;40(11):892-8. doi: 10.1055/s-2008-1077675. Epub 2008 Nov 13.
The aim of this retrospective study was to assess safety and efficacy of stepwise radical endoscopic resection (SRER) in patients with Barrett's esophagus with high-grade intraepithelial neoplasia (HGIN) or early cancer.
Patients undergoing SRER between 2000 and 2006 were retrospectively evaluated. Patients with Barrett's esophagus who also had HGIN or early cancer were included if they had no signs of submucosal infiltration or metastases. SRER was performed using the cap-technique, at 8-week intervals until all Barrett's esophagus was removed. Follow-up endoscopy was scheduled every 6 months.
A total of 34 patients were included (31 male, mean 67 years, median Barrett's dimensions C1M4). HGIN / early cancer was eradicated in all patients in a median of two endoscopic resection sessions (IQR 1-2 sessions). Twelve patients underwent additional argon plasma coagulation for small islets or an irregular Z-line. Barrett's esophagus was eradicated in 28 patients (82 %). Complications occurred in 3/34 patients (9 %): two perforations, one delayed bleeding. In all, 19 patients (56 %) developed dysphagia, which was resolved with dilatation or stent placement. During a median follow-up period of 23 months (IQR 15 - 41 months), HGIN / early cancer recurred in three patients (9 %): two were retreated with endoscopic resection and one patient was referred for curative surgery. Five patients (15 %) had recurrence of nondysplastic Barrett's esophagus. At the end of the follow-up period all patients were free of HGIN / early cancer (one patient after surgery), and 23 patients (68 %) had complete endoscopic and histological eradication of Barrett's esophagus.
SRER resulted in complete eradication of HGIN/early cancer in all patients, and eradication of Barrett's esophagus in a majority of cases. A significant number of patients develop dysphagia, which can be successfully treated endoscopically.
本回顾性研究旨在评估逐步根治性内镜切除术（SRER）治疗巴雷特食管伴高级别上皮内瘤变（HGIN）或早期癌症患者的安全性和有效性。
对2000年至2006年间接受SRER治疗的患者进行回顾性评估。纳入巴雷特食管合并HGIN或早期癌症且无黏膜下浸润或转移迹象的患者。采用套扎技术进行SRER，每隔8周进行一次，直至所有巴雷特食管被切除。每6个月安排一次随访内镜检查。
共纳入34例患者（31例男性，平均年龄67岁，巴雷特食管尺寸中位数C1M4）。所有患者的HGIN/早期癌症在中位2次内镜切除术中被根除（四分位间距1 - 2次）。12例患者因小病灶或不规则Z线接受了额外的氩离子凝固术。28例患者（82%）的巴雷特食管被根除。34例患者中有3例（9%）发生并发症：2例穿孔，1例延迟出血。共有19例患者（56%）出现吞咽困难，通过扩张或置入支架得以缓解。在中位随访期23个月（四分位间距15 - 41个月）内，3例患者（9%）的HGIN/早期癌症复发：2例接受内镜切除再次治疗，1例患者接受根治性手术。5例患者（15%）出现无发育异常的巴雷特食管复发。随访期末，所有患者均无HGIN/早期癌症（1例患者术后），23例患者（68%）实现内镜及组织学上巴雷特食管的完全根除。
SRER可使所有患者的HGIN/早期癌症完全根除，多数情况下可根除巴雷特食管。相当数量的患者出现吞咽困难，可通过内镜成功治疗。
