Section of Gastroenterology, Center for Endoscopic Research and Therapeutics, University of Chicago Medical Center, Illinois, USA.
Am J Gastroenterol. 2012 Jun;107(6):827-33. doi: 10.1038/ajg.2012.70.
Endotherapy is now the mainstay of therapy for Barrett's associated neoplasia. The approach should begin with confirmation of neoplasia by a gastrointestinal pathologist, patient counseling, and appropriate endoscopic work up. Detailed examination with high-resolution white light endoscopy is the most important tool for detection of neoplasia. Further validation studies are needed for many enhanced imaging modalities before being recommended as part of the standard work up and assessment of patients with Barrett's esophagus (BE). Endoscopic mucosal resection is required for any visible lesion in the setting of dysplasia for accurate histological diagnosis. The remainder of the epithelium may be treated with resection or ablative therapy, followed by adequate surveillance. Patients with nondysplastic Barrett's require further risk stratification before incorporation of ablative therapy for this population. The future will fortify the endoscopic role in Barrett's with validation trials for endoscopic assessment, further long-term results for each of the treatment modalities, potential risk stratification for patients with BE, and improved guidelines for surveillance after therapy.
内镜治疗目前是 Barrett 相关肿瘤的主要治疗方法。该方法应从胃肠道病理学家确认肿瘤、患者咨询和适当的内镜检查开始。通过高分辨率白光内镜进行详细检查是检测肿瘤的最重要工具。在推荐将许多增强成像方式作为 Barrett 食管 (BE) 患者标准检查和评估的一部分之前，还需要进行更多的验证研究。对于有异型增生的任何可见病变，均需要进行内镜黏膜切除术以进行准确的组织学诊断。对于其余上皮组织，可以采用切除或消融治疗，然后进行充分的监测。对于无异型增生的 Barrett 患者，在对该人群进行消融治疗之前，需要进一步进行风险分层。未来将通过验证性试验来强化 Barrett 内镜治疗的作用，包括内镜评估、每种治疗方法的长期结果、BE 患者的潜在风险分层以及治疗后监测的指南改善。
