Jain Deepanshu, Singhal Shashideep
Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, TX, USA.
Clin Endosc. 2016 May;49(3):241-56. doi: 10.5946/ce.2015.099. Epub 2016 Mar 7.
Advances in diagnostic modalities and improvement in surveillance programs for Barrett esophagus has resulted in an increase in the incidence of superficial esophageal cancers (SECs). SEC, due to their limited metastatic potential, are amenable to non-invasive treatment modalities. Endoscopic ultrasound, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are some of the new modalities that gastroenterologists have used over the last decade to diagnose and treat SEC. However, esophageal stricture (ES) is a very common complication and a major cause of morbidity post-ESD. In the past few years, there has been a tremendous effort to reduce the incidence of ES among patients undergoing ESD. Steroids have shown the most consistent results over time with minimal complications although the preferred mode of delivery is debatable, with both systemic and local therapy having pros and cons for specific subgroups of patients. Newer modalities such as esophageal stents, autologous cell sheet transplantation, polyglycolic acid, and tranilast have shown promising results but the depth of experience with these methods is still limited. We have summarized case reports, prospective single center studies, and randomized controlled trials describing the various methods intended to reduce the incidence of ES after ESD. Indications, techniques, outcomes, limitations, and reported complications are discussed.
巴雷特食管诊断方法的进步以及监测方案的改进导致浅表食管癌（SECs）发病率上升。由于SECs转移潜能有限，适合采用非侵入性治疗方式。内镜超声、内镜黏膜切除术和内镜黏膜下剥离术（ESD）是胃肠病学家在过去十年中用于诊断和治疗SECs的一些新方法。然而，食管狭窄（ES）是一种非常常见的并发症，也是ESD术后发病的主要原因。在过去几年中，人们为降低接受ESD患者的ES发病率付出了巨大努力。随着时间的推移，类固醇显示出最一致的效果，并发症最少，尽管首选的给药方式存在争议，全身治疗和局部治疗对特定亚组患者都有优缺点。食管支架、自体细胞片移植、聚乙醇酸和曲尼司特等新方法已显示出有前景的结果，但这些方法的经验深度仍然有限。我们总结了病例报告、前瞻性单中心研究和随机对照试验，这些研究描述了旨在降低ESD术后ES发病率的各种方法。讨论了适应证、技术、结果、局限性和报告的并发症。
