Perry Kyle A, Walker Jon P, Salazar Mario, Suzo Andrew, Hazey Jeffrey W, Melvin W Scott
Surg Endosc. 2014 Mar;28(3):777-82. doi: 10.1007/s00464-013-3240-9.
Esophagectomy has been the standard treatment for Barrett's esophagus (BE) with high-grade dysplasia (HGD) and intramucosal cancer (IMC). Recently, endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) have become the preferred treatment for these patients in some centers. We report a single institution series of patients undergoing endoscopic management of HGD and IMC.
Nineteen patients underwent endoscopic treatment for HGD or IMC between 2009 and 2012. The primary outcome measure was progression of BE necessitating esophagectomy. Secondary outcomes included complete eradication of intestinal metaplasia (CE-IM), complete eradication of dysplasia (CE-D), recurrence or progression of BE or dysplasia, and complications. Patients were followed for a median follow-up interval of 19 months following completion of RFA treatment.
Three patients (16 %) had a presenting diagnosis of IMC, and 16 (84 %) were treated for HGD. Twelve (63 %) had long-segment BE; the median length of BE was 5 cm. Ten (53 %) patients underwent EMR prior to RFA. CE-D was achieved in 88 % of patients, and CE-IM was achieved in 65 % of patients. A median of 2 (1-7) treatments were required, and there were no immediate post-procedure complications. Two patients developed recurrent dysplasia following complete eradication of BE, and each case was successfully managed with repeat RFA. Three patients (16 %) required esophagectomy within 6 months following RFA. A complete surgical resection was achieved in each case, and none of the patients developed lymph node metastases.
Complete eradication of HGD and IMC can be achieved via endoscopic therapy, thus avoiding esophagectomy in the majority of patients. However, a subset of patients will fail this treatment approach and will require surgical resection. With aggressive endoscopic treatment and surveillance, these patients can be identified at an early stage while curative resection is still possible.
食管切除术一直是治疗伴有高级别异型增生（HGD）和黏膜内癌（IMC）的巴雷特食管（BE）的标准治疗方法。近来，在一些中心，内镜黏膜切除术（EMR）和射频消融术（RFA）已成为这些患者的首选治疗方法。我们报告了一家机构对HGD和IMC进行内镜治疗的一系列病例。
2009年至2012年间，19例患者接受了针对HGD或IMC的内镜治疗。主要观察指标是BE进展至需要进行食管切除术。次要观察指标包括肠化生的完全根除（CE-IM）、异型增生的完全根除（CE-D）、BE或异型增生的复发或进展以及并发症。在RFA治疗完成后，对患者进行了中位随访期为19个月的随访。
3例患者（16%）初诊为IMC，16例（84%）接受HGD治疗。12例（63%）有长段BE；BE的中位长度为5 cm。10例（53%）患者在RFA前接受了EMR。88%的患者实现了CE-D，65%的患者实现了CE-IM。平均需要2（1 - 7）次治疗，术后无即刻并发症。2例患者在BE完全根除后出现异型增生复发，每例均通过重复RFA成功处理。3例患者（16%）在RFA后6个月内需要进行食管切除术。每例均实现了完整的手术切除，且无一例患者发生淋巴结转移。
通过内镜治疗可实现HGD和IMC的完全根除，从而避免大多数患者进行食管切除术。然而，一部分患者这种治疗方法会失败，需要手术切除。通过积极的内镜治疗和监测，这些患者在仍可进行根治性切除时可被早期识别。
