早期巴雷特肿瘤的内镜治疗：适应证的扩展与新挑战

Endoscopic Treatment of Early Barrett's Neoplasia: Expanding Indications, New Challenges.

作者信息

Pech Oliver

机构信息

Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital Regensburg, Teaching Hospital of the University of Regensburg, Pruefeninger Str. 86, Regensburg, D-93049, Germany.

出版信息

Adv Exp Med Biol. 2016;908:99-109. doi: 10.1007/978-3-319-41388-4_6.

DOI:10.1007/978-3-319-41388-4_6

PMID:27573769

Abstract

Endoscopic therapy of early Barrett's neoplasia is nowadays the treatment of choice and recommended over surgery in most current guidelines. Recent data suggest radiofrequency ablation of low-grade intraepithelial neoplasia when confirmed by an expert pathologist. Endoscopic therapy of high-grade intraepithelial neoplasia and mucosal Barrett's adenocarcinoma consists of two steps: first endoscopic resection of all visible lesions, and second ablation of the remaining flat Barrett's mucosa to reduce the rate of recurrences and metachronous neoplasia. The preferred ablation method is radiofrequency ablation. In case of Barrett's adenocarcinoma with incipient submucosal invasion, endoscopic treatment can be considered curative when there are no further risk factors present.

摘要

如今，早期巴雷特肿瘤的内镜治疗是首选治疗方法，在大多数现行指南中，其被推荐用于替代手术治疗。近期数据表明，当经专家病理学家确诊为低级别上皮内瘤变时，可采用射频消融治疗。高级别上皮内瘤变和黏膜巴雷特腺癌的内镜治疗包括两个步骤：首先，对所有可见病变进行内镜切除；其次，对剩余的扁平巴雷特黏膜进行消融，以降低复发率和异时性肿瘤的发生率。首选的消融方法是射频消融。对于伴有早期黏膜下浸润的巴雷特腺癌，如果不存在其他危险因素，可考虑内镜治疗作为根治性治疗。