Belghazi Kamar, Cipollone Ilaria, Bergman Jacques J G H M, Pouw Roos E
Academic Medical Center, Department of Gastroenterology and Hepatology, Room C2-329, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Curr Treat Options Gastroenterol. 2016 Mar;14(1):1-18. doi: 10.1007/s11938-016-0080-4.
Barrett's esophagus (BE) is the most important risk factor for esophageal adenocarcinoma. Through the sequence of no dysplasia to low-grade dysplasia (LGD) and high-grade dysplasia (HGD), eventually early cancer (EC) may develop. The risk of neoplastic progression is relatively low, 0.5-0.9 % per patient per year. However, once diagnosed, esophageal adenocarcinoma is often irresectable, and 5-year survival is only 15 %. Therefore, non-dysplastic BE patients are kept under endoscopic surveillance to detect early neoplasia in a curable stage. In case of LGD confirmed by an expert pathologist, risk of neoplastic progression is high. In these confirmed LGD patients, prophylactic ablation using radiofrequency ablation (RFA) of the Barrett's segment has proven to significantly reduce risk of neoplastic progression. Once patients are diagnosed with HGD or EC, they have a clear indication for endoscopic treatment. The cornerstone for endoscopic management of early Barrett's neoplasia is endoscopic resection of mucosal abnormalities. Endoscopic resection (ER) provides a large tissue specimen for accurate histological evaluation to select those patients for further endoscopic management, who have neoplasia limited to the mucosa, well to moderately differentiated and without lymph-vascular invasion. After ER, the remainder of the Barrett's mucosa can be eradicated with RFA, to prevent occurrence of metachronous lesions.
巴雷特食管（BE）是食管腺癌最重要的危险因素。从无异型增生发展到低级别异型增生（LGD）和高级别异型增生（HGD），最终可能发展为早期癌症（EC）。肿瘤进展的风险相对较低，每位患者每年为0.5 - 0.9%。然而，一旦确诊为食管腺癌，通常无法切除，5年生存率仅为15%。因此，对无异型增生的BE患者进行内镜监测，以在可治愈阶段检测早期肿瘤。如果经专家病理学家确诊为LGD，肿瘤进展的风险很高。在这些确诊为LGD的患者中，使用射频消融（RFA）对巴雷特段进行预防性消融已被证明可显著降低肿瘤进展的风险。一旦患者被诊断为HGD或EC，他们就有明确的内镜治疗指征。早期巴雷特肿瘤内镜治疗的基石是对黏膜异常进行内镜切除。内镜切除（ER）提供了一个大的组织标本用于准确的组织学评估，以选择那些肿瘤局限于黏膜、分化良好至中等且无淋巴血管侵犯的患者进行进一步的内镜治疗。ER后，巴雷特黏膜的其余部分可用RFA根除，以防止异时性病变的发生。
