Institut des maladies de l'appareil digestif, CHU de Nantes, Nantes, France.
Best Pract Res Clin Gastroenterol. 2013 Apr;27(2):187-204. doi: 10.1016/j.bpg.2013.03.011.
Adenocarcinoma developed in Barrett's oesophagus is a tumour with an increasing incidence and still a poor prognosis. The only marker that can be used for surveillance remains dysplasia (intraepithelial neoplasia), especially when it is high-grade, that precedes intramucosal carcinoma. New forms of dysplasia have been described in complement to the classical intestinal type (foveolar dysplasia, basal crypt dysplasia). High-grade dysplasia and intramucosal carcinoma are diagnosed on biopsies taken during endoscopy. Standard endoscopy is now challenged by various techniques that represent recent major technical improvements (chromoendoscopy, virtual chromoendoscopy, optical frequency domain imaging, confocal laser endomicroscopy). In numerous cases, high-grade dysplasia and intramucosal carcinoma can be treated by endoscopic procedures, allowing a precise histopathological diagnosis on the resected specimen (endoscopic mucosal resection, submucosal endoscopic dissection) or destroying the neoplastic tissue. Radiofrequency ablation is currently considered as the best available technique for treatment of flat high grade dysplasia and for eradication of residual Barrett's mucosa after focal endoscopic mucosal resection.
巴雷特食管腺癌的发病率不断上升，预后仍然较差。目前唯一可用于监测的标志物仍然是异型增生（上皮内瘤变），尤其是高级别异型增生，它先于黏膜内癌。除了经典的肠型异型增生（凹窝型异型增生、基底隐窝异型增生）外，还描述了新的异型增生形式。高级别异型增生和黏膜内癌是在内镜检查时通过活检诊断出来的。标准的内镜检查现在受到各种技术的挑战，这些技术代表了最近的重大技术改进（染色内镜、虚拟染色内镜、光学频域成像、共聚焦激光内镜检查）。在许多情况下，高级别异型增生和黏膜内癌可以通过内镜治疗，允许对切除标本进行精确的组织病理学诊断（内镜黏膜切除术、黏膜下内镜剥离术）或破坏肿瘤组织。射频消融术目前被认为是治疗平坦高级别异型增生和消除局灶性内镜黏膜切除术后残留巴雷特食管黏膜的最佳方法。
