Department of Medicine, Division of Gastroenterology and Hepatology, Dallas VA Medical Center, University of Texas Southwestern Medical Center, Dallas, Texas 75216, USA.
Curr Opin Gastroenterol. 2013 Jul;29(4):446-53. doi: 10.1097/MOG.0b013e3283622848.
PURPOSE OF REVIEW: Endoscopic eradication therapy is frequently used to treat dysplasia and early cancers in Barrett's esophagus. This review addresses some of the recent developments in the field of endoscopic eradication therapy for Barrett's esophagus. RECENT FINDINGS: Data on the effectiveness of Barrett's esophagus ablation programs have been published recently, with excellent results for dysplasia eradication. Studies describing long-term results have shed light on the durability of endoscopic ablation, with recurrence of Barrett's esophagus and neoplasia seen in some cases, particularly at the gastroesophageal junction. Risk factors for failed ablation include longer Barrett's esophagus segments and persistent gastroesophageal reflux. New developments include studies combining radiofrequency ablation (RFA) and endoscopic mucosal resection into a single endoscopic session, endoscopic submucosal dissection for Barrett's esophagus neoplasia, and a simplified RFA algorithm. New data on the cost-effectiveness of RFA have also been published, suggesting that RFA is cost-effective for both high-grade and low-grade dysplasia, but not for nondysplastic Barrett's esophagus. A systematic review has shown that lymph node metastases are rare (∼2%) with intramucosal adenocarcinoma, supporting the use of endoscopic eradication for that lesion. SUMMARY: Research and clinical experience with the endoscopic therapies for Barrett's esophagus continue to grow. Proper patient selection and technique are critical for ensuring a good outcome. Endoscopic surveillance after any of the ablative therapies still appears to be necessary.
目的综述:内镜下消除疗法常用于治疗巴雷特食管的异型增生和早期癌症。本综述介绍了巴雷特食管内镜消除治疗领域的一些最新进展。
最近发现:最近公布了巴雷特食管消融方案有效性的数据,对异型增生的消除效果极佳。描述长期结果的研究揭示了内镜消融的持久性,在某些情况下,特别是在胃食管交界处,可见巴雷特食管和肿瘤的复发。消融失败的危险因素包括更长的巴雷特食管段和持续的胃食管反流。新的发展包括将射频消融(RFA)和内镜黏膜切除术结合到单个内镜治疗中、用于治疗巴雷特食管肿瘤的内镜黏膜下剥离术,以及简化的 RFA 算法。RFA 的成本效益的新数据也已公布,表明 RFA 对高级别和低级别异型增生都是具有成本效益的,但对非异型增生性巴雷特食管则不然。一项系统评价表明,黏膜内腺癌的淋巴结转移率较低(约 2%),支持对该病变进行内镜消除。
总结:巴雷特食管的内镜治疗的研究和临床经验仍在不断发展。适当的患者选择和技术对于确保良好的治疗效果至关重要。任何消融治疗后的内镜监测似乎仍然是必要的。
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