Espino Alberto, Cirocco Maria, Dacosta Ralph, Marcon Norman
Division of Gastroenterology, Department of Medicine, The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, ON, Canada.
Department of Medical Biophysics, Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, University of Toronto Faculty of Medicine, Toronto, ON, Canada.
Clin Endosc. 2014 Jan;47(1):47-54. doi: 10.5946/ce.2014.47.1.47. Epub 2014 Jan 24.
Advanced esophageal adenocarcinomas arising from Barrett esophagus (BE) are tumors with an increasing incidence and poor prognosis. The aim of endoscopic surveillance of BE is to detect dysplasia, particularly high-grade dysplasia and intramucosal cancers that can subsequently be treated endoscopically before progression to invasive cancer with lymph node metastases. Current surveillance practice standards require the collection of random 4-quadrant biopsy specimens over every 1 to 2 cm of BE (Seattle protocol) to detect dysplasia with the assistance of white light endoscopy, in addition to performing targeted biopsies of recognizable lesions. This approach is labor-intensive but should currently be considered state of the art. Chromoendoscopy, virtual chromoendoscopy (e.g., narrow band imaging), and confocal laser endomicroscopy, in addition to high-definition standard endoscopy, might increase the diagnostic yield for the detection of dysplastic lesions. Until these modalities have been demonstrated to enhance efficiency or cost effectiveness, the standard protocol will remain careful examination using conventional off the shelf high-resolution endoscopes, combined with as longer inspection time which is associated with increased detection of dysplasia.
起源于巴雷特食管（BE）的晚期食管腺癌发病率不断上升且预后较差。对BE进行内镜监测的目的是检测发育异常，尤其是高级别发育异常和黏膜内癌，这些病变随后可在内镜下进行治疗，以防进展为伴有淋巴结转移的浸润性癌。目前的监测实践标准要求在BE的每1至2厘米范围内随机采集4象限活检标本（西雅图方案），借助白光内镜检测发育异常，此外还要对可识别的病变进行靶向活检。这种方法劳动强度大，但目前应被视为先进技术。除了高清标准内镜检查外，染色内镜、虚拟染色内镜（如窄带成像）和共聚焦激光显微内镜检查可能会提高发育异常病变的诊断率。在这些方法被证明能提高效率或成本效益之前，标准方案仍将是使用传统的现成高分辨率内镜进行仔细检查，并延长检查时间，这与发育异常检测率的提高有关。
