Han Samuel, Wani Sachin
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, 1635 Aurora Court, Rm 2.031, Aurora, CO, 80045, USA.
Curr Treat Options Gastroenterol. 2017 Jun;15(2):241-255. doi: 10.1007/s11938-017-0136-0.
Barrett's esophagus (BE) is a well-established premalignant condition for esophageal adenocarcinoma (EAC); a cancer that is associated with a poor 5-year survival rate. Several strategies have been explored in the context of reducing the burden of EAC. Endoscopic eradication therapy (EET) is considered the standard of care for the management of patients with BE with dysplasia and early neoplasia; a practice that has been endorsed by all gastroenterology societal guidelines. The effectiveness of EET has been demonstrated in multiple studies and contemporary management includes a combination of endoscopic mucosal resection (EMR) of all visible lesions followed by eradication of the remaining BE using ablative techniques of which radiofrequency ablation (RFA) has the best evidence supporting effectiveness and safety. These techniques are being used increasingly at academic tertiary care centers and community practices. In this era of value-based health care, there is increased focus on the establishment, documentation, and reporting of quality indicators; indicators that are important to physicians, patients, and payers. The purpose of this review is to highlight the current status of quality indicators in EET for the management of patients with BE-related neoplasia and discuss the future steps required to ensure that these quality indicators are uniformly incorporated into practice.
巴雷特食管(BE)是一种公认的食管腺癌(EAC)癌前病变;EAC是一种5年生存率较低的癌症。人们已经探索了多种减轻EAC负担的策略。内镜根除治疗(EET)被认为是治疗不典型增生和早期肿瘤形成的BE患者的标准治疗方法;这一做法已得到所有胃肠病学学会指南的认可。多项研究已证明EET的有效性,当代治疗方法包括对所有可见病变进行内镜黏膜切除术(EMR),然后使用消融技术根除剩余的BE,其中射频消融(RFA)在有效性和安全性方面有最充分的证据支持。这些技术在学术三级医疗中心和社区医疗机构中使用得越来越多。在这个基于价值的医疗保健时代,人们越来越关注质量指标的建立、记录和报告;这些指标对医生、患者和支付方都很重要。本综述的目的是强调EET中质量指标在管理BE相关肿瘤患者方面的现状,并讨论确保这些质量指标统一纳入实践所需的未来步骤。