Bechara Robert, Inoue Haruhiro
Robert Bechara, Haruhiro Inoue, Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Koto-ku, Tokyo 135-0061, Japan.
World J Gastrointest Endosc. 2015 May 16;7(5):481-95. doi: 10.4253/wjge.v7.i5.481.
Over the past 30 years, the field of endoscopy has witnessed several advances. With the advent of endoscopic mucosal resection, removal of large mucosal lesions have become possible. Thereafter, endoscopic submucosal resection was refined, permitting en bloc removal of large superficial neoplasms. Such techniques have facilitated the development of antireflux mucosectomy, a promising novel treatment for gastroesophageal reflux. The introduction and use of over the scope clips has allowed for endoscopic closure of defects in the gastrointestinal tract, which were traditionally treated with surgical intervention. With the development of per-oral endoscopic myotomy (POEM), the treatment of achalasia and spastic disorders of the esophagus have been revolutionized. From the submucosal tunnelling technique developed for POEM, Per oral endoscopic tumor resection of subepithelial tumors was made possible. Simultaneously, advances in biotechnology have expanded esophageal stenting capabilities with the introduction of fully covered metal and plastic stents, as well as biodegradable stents. Once deemed a primarily diagnostic tool, endoscopy has quickly transcended to a minimally invasive intervention and therapeutic tool. These techniques are reviewed with regards to their application to benign disease of the esophagus.
在过去30年里,内镜领域取得了多项进展。随着内镜黏膜切除术的出现,切除大的黏膜病变成为可能。此后,内镜黏膜下切除术得到改进,能够整块切除大的浅表肿瘤。这些技术推动了抗反流黏膜切除术的发展,这是一种治疗胃食管反流的有前景的新方法。经内镜金属夹的引入和使用使得内镜下闭合胃肠道缺损成为可能,而这些缺损传统上需手术干预。随着经口内镜下肌切开术(POEM)的发展,贲门失弛缓症和食管痉挛性疾病的治疗发生了变革。基于为POEM开发的黏膜下隧道技术,经口内镜下切除上皮下肿瘤成为可能。同时,随着全覆膜金属支架、塑料支架以及可生物降解支架的引入,生物技术的进步扩大了食管支架置入的能力。内镜曾一度被视为主要的诊断工具,如今已迅速发展成为一种微创干预和治疗工具。本文就这些技术在食管良性疾病中的应用进行综述。