Ning Bo, Abdelfatah Mohamed M, Othman Mohamed O
The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA.
Ann Cardiothorac Surg. 2017 Mar;6(2):88-98. doi: 10.21037/acs.2017.03.15.
Mortality from esophageal cancer remains high despite advances in medical therapy. Although the incidence of squamous cell carcinoma of the esophagus remains unchanged, the incidence of the esophageal adenocarcinoma has increased over time. Gastroesophageal reflux disease (GERD and obesity are contributing factors to the development of Barrett's esophagus and subsequent development of adenocarcinoma. Early recognition of the disease can lead to resection of esophageal cancer prior to the development of lymphovascular invasion. Various modalities have been implemented to aid identification of precancerous lesions and early esophageal cancer. Chromoendoscopy, narrowband imaging and endoscopic ultrasound examination are typically used for evaluating early esophageal lesions. Recently, confocal laser endomicroscopy (CLE) and volumetric laser scanning were implemented with promising results. Endoscopic management of early esophageal cancer may be done using endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Both techniques allow resection of the mucosa (and possibly a portion of the submucosa) containing the early tumor without interruption of deeper layers. A submucosal injection creating a cushion coupled with snare resection or cap assisted mucosal suction followed by ligation and snare resection are the most common techniques of EMR. EMR can remove lesions less than 2 cm in size en bloc. Larger lesions may require resection in piecemeal fashion. This may limit assessment of the margins of the lesion and orienting the lesion's border. ESD offers en bloc dissection of the lesion regardless of its size. ESD is performed with specialized needle knives, which allow incision followed by careful dissection of the lesion within the submucosal layer. Tumor recurrence after ESD is rare but the technique is labor intensive and has an increased risk of perforation. Esophageal stenosis remains a concern after extensive EMR or ESD. Dilation with balloon or stent placement is usually sufficient to treat post-resection stenosis.
尽管医学治疗取得了进展，但食管癌的死亡率仍然很高。虽然食管鳞状细胞癌的发病率保持不变，但食管腺癌的发病率随时间有所增加。胃食管反流病（GERD）和肥胖是巴雷特食管发生及随后腺癌发展的促成因素。疾病的早期识别可导致在发生淋巴管浸润之前切除食管癌。已采用各种方法来辅助识别癌前病变和早期食管癌。色素内镜检查、窄带成像和内镜超声检查通常用于评估早期食管病变。最近，共聚焦激光显微内镜检查（CLE）和容积激光扫描已得到应用，效果良好。早期食管癌的内镜治疗可采用内镜黏膜切除术（EMR）或内镜黏膜下剥离术（ESD）。这两种技术都可切除包含早期肿瘤的黏膜（可能还有一部分黏膜下层），而不会打断更深层组织。通过黏膜下注射形成一个垫子，再结合圈套切除术或帽辅助黏膜抽吸术，随后进行结扎和圈套切除术，是EMR最常用的技术。EMR可整块切除直径小于2 cm的病变。较大的病变可能需要分块切除。这可能会限制对病变边缘的评估以及确定病变边界。无论病变大小，ESD都能整块切除病变。ESD使用专门的针刀进行，先切开，然后在黏膜下层仔细剥离病变。ESD后肿瘤复发很少见，但该技术劳动强度大，穿孔风险增加。广泛的EMR或ESD后，食管狭窄仍然是一个问题。球囊扩张或放置支架通常足以治疗切除术后的狭窄。
