Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Clin Gastroenterol Hepatol. 2010 Sep;8(9):743-54; quiz e96. doi: 10.1016/j.cgh.2010.05.030. Epub 2010 Jun 10.
Endoscopic mucosal resection has expanded the role of the gastroenterologist in the management of esophageal neoplasia from screening and diagnosis to staging and endoscopic treatment. Its rise to prominence is a reflection of the long-identified need to obtain histologic information regarding depth of invasion and neoplastic margins during therapy that previously could not be achieved with ablative techniques. The resultant improvement in diagnosis and staging has allowed for better selection of patients for endoscopic therapy who may be spared invasive surgery. The clinical indications, endoscopic techniques, outcomes, and complications in the management of esophageal neoplasia are reviewed. Training requirements to achieve proficiency in endoscopic mucosal resection as well as potential quality measures to assess competence also are proposed in this review.
内镜黏膜切除术扩大了消化内科医生在食管肿瘤管理中的作用,从筛查和诊断扩展到分期和内镜治疗。它的兴起反映了长期以来在治疗过程中获得关于浸润深度和肿瘤边缘的组织学信息的需求,而以前的消融技术无法实现这一需求。诊断和分期的改善使得更好地选择可能免于接受侵入性手术的患者进行内镜治疗成为可能。本文回顾了食管肿瘤管理中的临床适应证、内镜技术、结果和并发症。本文还提出了在内镜黏膜切除术中达到熟练程度的培训要求以及评估能力的潜在质量措施。