Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Dig Endosc. 2013 Mar;25 Suppl 1:20-8. doi: 10.1111/den.12047.
Recently developed endoscopic resection (endoscopic submucosal dissection [ESD]/ endoscopic mucosal resection) has dramatically changed the therapeutic approach for Barrett's esophageal cancer. The rationale for endoscopic resection is that lesions confined to the mucosal layer have negligible risk for developing lymph node metastasis and can be successfully eradicated by endoscopic treatment as a curative treatment with minimal invasiveness. According to some reports that analyzed the rate of lymph-node involvement relative to the depth of mucosal or submucosal tumor infiltration, endoscopic resection is clearly indicated for intramucosal carcinoma and might be extended to lesions with invasion into the submucosa (<200 μm, sm1) because of the low risk for lymph node metastasis. Most Japanese experts recommend ESD for Barrett's esophageal cancer after accurate diagnosis of the margin of cancer using narrow band imaging with magnifying endoscopy because of its high curative rate. However, few studies have evaluated the long-term outcomes of endoscopic resection for Barrett's esophageal cancer in Japan. Further investigations should be conducted to establish endoscopic resection for Barrett's esophageal cancer.
近年来发展起来的内镜下切除术(内镜黏膜下剥离术 [ESD]/内镜下黏膜切除术)极大地改变了 Barrett 食管食管癌的治疗方法。内镜下切除的理论基础是,局限于黏膜层的病变发生淋巴结转移的风险极小,可以通过内镜治疗成功消除,这种治疗方式具有微创和根治性的特点。根据一些分析黏膜或黏膜下肿瘤浸润深度与淋巴结转移率关系的报告,内镜下切除显然适用于黏膜内癌,并且由于淋巴结转移风险较低,可能会扩展到侵犯黏膜下层(<200μm,sm1)的病变。由于其高治愈率,大多数日本专家建议在使用放大内镜窄带成像准确诊断癌症边缘后,对 Barrett 食管食管癌行 ESD。然而,在日本,很少有研究评估内镜下切除 Barrett 食管食管癌的长期结果。应进一步开展研究以确立 Barrett 食管食管癌的内镜下切除术。
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