Hudson Matthew, Lin Cui Li, Habr Fadlallah
Department of Internal Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI, USA.
Hosp Pract (1995). 2011 Feb;39(1):170-80. doi: 10.3810/hp.2011.02.388.
Barrett's esophagus (BE) is a premalignant condition that predisposes patients to esophageal adenocarcinoma. This risk increases with increasing dysplasia, especially in patients with BE and high-grade dysplasia. Radical esophagectomy had long been the only option for these patients; however, it has been associated with significant morbidity and mortality. Endoscopic therapies have been increasingly used as an alternative to radical esophagectomy given the minimally invasive nature and tolerability of the procedure relative to surgery. Currently, the most widely used endoscopic therapies include endoscopic mucosal resection, photodynamic therapy, CryoSpray ablation, and radiofrequency ablation. Retrospective and prospective studies on the use of each of these modalities in patients with nondysplastic BE, dysplastic BE, and early esophageal cancer have demonstrated their effectiveness in eradication of dysplasia with or without reversion of Barrett's epithelium to normal squamous epithelium of the esophagus. These modalities are well tolerated, safe, and have few side effects. Ultimately, more research is needed regarding their ability to fully displace surgical intervention as the gold standard, although at this point their role in poor operative candidates or patients seeking conservative approaches remains promising.
巴雷特食管（BE）是一种癌前病变，使患者易患食管腺癌。随着发育异常程度的增加，这种风险也会增加，尤其是在患有BE和高级别发育异常的患者中。长期以来，根治性食管切除术一直是这些患者的唯一选择；然而，它与显著的发病率和死亡率相关。鉴于内镜治疗相对于手术具有微创性和耐受性，其已越来越多地被用作根治性食管切除术的替代方法。目前，使用最广泛的内镜治疗方法包括内镜黏膜切除术、光动力疗法、冷冻喷雾消融术和射频消融术。对这些方法在非发育异常性BE、发育异常性BE和早期食管癌患者中的应用进行的回顾性和前瞻性研究表明，它们在根除发育异常方面是有效的，无论巴雷特上皮是否恢复为食管正常鳞状上皮。这些方法耐受性良好、安全且副作用少。最终，尽管目前它们在手术条件差的患者或寻求保守治疗方法的患者中的作用仍然很有前景，但关于它们能否完全取代手术干预作为金标准，还需要更多的研究。
