Luigiano Carmelo, Iabichino Giuseppe, Eusebi Leonardo Henry, Arena Monica, Consolo Pierluigi, Morace Carmela, Opocher Enrico, Mangiavillano Benedetto
Unit of Digestive Endoscopy, San Paolo Hospital, Via A. Di Rudiní, No. 8, 20142 Milano, Italy.
HPB Endoscopy, Royal Free Hospital, London, UK; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Gastroenterol Res Pract. 2016;2016:4249510. doi: 10.1155/2016/4249510. Epub 2016 Dec 14.
Barrett's esophagus is a condition in which the normal squamous lining of the esophagus has been replaced by columnar epithelium containing intestinal metaplasia induced by recurrent mucosal injury related to gastroesophageal reflux disease. Barrett's esophagus is a premalignant condition that can progress through a dysplasia-carcinoma sequence to esophageal adenocarcinoma. Multiple endoscopic ablative techniques have been developed with the goal of eradicating Barrett's esophagus and preventing neoplastic progression to esophageal adenocarcinoma. For patients with high-grade dysplasia or intramucosal neoplasia, radiofrequency ablation with or without endoscopic resection for visible lesions is currently the most effective and safe treatment available. Recent data demonstrate that, in patients with Barrett's esophagus and low-grade dysplasia confirmed by a second pathologist, ablative therapy results in a statistically significant reduction in progression to high-grade dysplasia and esophageal adenocarcinoma. Treatment of dysplastic Barrett's esophagus with radiofrequency ablation results in complete eradication of both dysplasia and of intestinal metaplasia in a high proportion of patients with a low incidence of adverse events. A high proportion of treated patients maintain the neosquamous epithelium after successful treatment without recurrence of intestinal metaplasia. Following successful endoscopic treatment, endoscopic surveillance should be continued to detect any recurrent intestinal metaplasia and/or dysplasia. This paper reviews all relevant publications on the endoscopic management of Barrett's esophagus using radiofrequency ablation.
巴雷特食管是一种食管正常鳞状上皮被柱状上皮取代的病症，这种柱状上皮含有因胃食管反流病相关的反复黏膜损伤所诱发的肠化生。巴雷特食管是一种癌前病变，可通过发育异常 - 癌序列发展为食管腺癌。为了根除巴雷特食管并预防肿瘤进展为食管腺癌，已开发出多种内镜消融技术。对于高级别发育异常或黏膜内肿瘤患者，目前对于可见病变采用射频消融联合或不联合内镜切除是最有效且安全的治疗方法。近期数据表明，在经另一位病理学家确诊为巴雷特食管且伴有低级别发育异常的患者中，消融治疗可使进展为高级别发育异常和食管腺癌的比例在统计学上显著降低。采用射频消融治疗发育异常的巴雷特食管，可使高比例患者的发育异常和肠化生完全消除，且不良事件发生率较低。高比例的接受治疗患者在成功治疗后维持新生鳞状上皮，肠化生无复发。在内镜治疗成功后，应继续进行内镜监测以检测任何复发性肠化生和/或发育异常。本文综述了关于使用射频消融进行巴雷特食管内镜治疗的所有相关出版物。
