Dumot J A, Greenwald B D
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
Endoscopy. 2008 Dec;40(12):1026-32. doi: 10.1055/s-0028-1103414. Epub 2008 Dec 8.
A variety of endoscopic ablation modalities are available for the treatment of Barrett's esophagus. Multiple studies have evaluated the use of argon plasma coagulation, mostly in nondysplastic Barrett's esophagus. Significant variations in technique, end points, and follow-up exist between studies, but in most cases argon plasma coagulation is associated with unacceptable rates of persistent intestinal metaplasia and recurrence after completion of treatment. In addition, serious adverse events including perforation and stricture formation are reported. Multipolar electrocoagulation has been studied less thoroughly, but in prospective trials significant rates of persistent and recurrent intestinal metaplasia have also been reported. Lasers and heater probes have been tried in small numbers. Endoscopic cryotherapy ablation is a relatively new technique with studies focusing on high-grade dysplasia and early-stage cancer in high-risk patients. It has an acceptable safety profile, and early results show response in a significant number of patients in whom other modalities have failed.
有多种内镜消融方式可用于治疗巴雷特食管。多项研究评估了氩等离子体凝固术的应用，主要用于非发育异常的巴雷特食管。各研究在技术、终点和随访方面存在显著差异，但在大多数情况下，氩等离子体凝固术与治疗后持续性肠化生和复发率过高相关。此外，还报告了包括穿孔和狭窄形成在内的严重不良事件。对多极电凝术的研究不够深入，但在前瞻性试验中也报告了较高的持续性和复发性肠化生率。激光和热探头仅进行了少量试验。内镜冷冻消融术是一种相对较新的技术，研究主要集中在高危患者的高级别发育异常和早期癌症。它具有可接受的安全性，早期结果显示，在其他方式治疗失败的大量患者中，该技术有疗效。
