Schlottmann Francisco, Patti Marco G
Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
Center for Esophageal Diseases and Swallowing, University of North Carolina, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA.
J Gastrointest Surg. 2017 Aug;21(8):1354-1360. doi: 10.1007/s11605-017-3371-8. Epub 2017 Mar 28.
Around 10-15% of patients with gastroesophageal reflux disease will develop Barrett's esophagus (BE). The development of novel endoscopic modalities has changed the management of BE in the last decade.
The aim of this study was to review the current evidence for the treatment of BE with and without dysplasia.
In patients with BE without dysplasia, antireflux surgery should not be suggested as a modality to prevent the malignant transformation of BE, but its indications should be the same as for other patients with gastroesophageal reflux. Endoscopic surveillance at intervals of 3-5 years is recommended for these patients. For patients with BE with low-grade dysplasia, radiofrequency ablation (RFA) is the preferred treatment modality, while endoscopic surveillance every 12 months is an acceptable alternative in patients with life-limiting comorbidities. For most patients with BE and high-grade dysplasia, RFA is the preferred treatment strategy. Patients with intramucosal adenocarcinoma (T1a), should be treated with EMR followed by ablative therapy, in order to eradicate the remaining intestinal metaplasia. Endoscopic resection may be suitable for low-risk T1b tumors (well-differentiated, without lymphovascular invasion, and with superficial submucosal invasion); however, further data are necessary to better risk stratify this group.
Patients with BE without dysplasia should undergo endoscopic surveillance every 3-5 years. Endoscopic ablative therapy (RFA) is the preferred treatment modality for dysplastic BE. Patients with T1a adenocarcinoma should be treated with EMR followed by ablative therapy. Low-risk T1b tumors may be suitable for endoscopic resection.
约10%-15%的胃食管反流病患者会发展为巴雷特食管（BE）。在过去十年中，新型内镜技术的发展改变了BE的治疗方式。
本研究旨在综述目前关于有或无异型增生的BE治疗的证据。
对于无异型增生的BE患者，不建议将抗反流手术作为预防BE恶变的一种方式，但其适应证应与其他胃食管反流患者相同。建议对这些患者每隔3-5年进行一次内镜监测。对于低度异型增生的BE患者，射频消融（RFA）是首选的治疗方式，而对于有危及生命的合并症的患者，每12个月进行一次内镜监测是一种可接受的替代方法。对于大多数高度异型增生的BE患者，RFA是首选的治疗策略。黏膜内腺癌（T1a）患者应先接受内镜黏膜切除术（EMR），然后进行消融治疗，以根除剩余的肠化生。内镜切除可能适用于低风险的T1b肿瘤（高分化、无脉管侵犯且黏膜下浅层侵犯）；然而，需要更多数据以更好地对该组进行风险分层。
无异型增生的BE患者应每隔3-5年接受一次内镜监测。内镜消融治疗（RFA）是异型增生性BE的首选治疗方式。T1a腺癌患者应先接受EMR，然后进行消融治疗。低风险的T1b肿瘤可能适合内镜切除。
