di Pietro Massimiliano, Canto Marcia I, Fitzgerald Rebecca C
MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom.
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Gastroenterology. 2018 Jan;154(2):421-436. doi: 10.1053/j.gastro.2017.07.041. Epub 2017 Aug 2.
Because the esophagus is easily accessible with endoscopy, early diagnosis and curative treatment of esophageal cancer is possible. However, diagnosis is often delayed because symptoms are not specific during early stages of tumor development. The onset of dysphagia is associated with advanced disease, which has a survival at 5 years lower than 15%. Population screening by endoscopy is not cost-effective, but a number of alternative imaging and cell analysis technologies are under investigation. The ideal screening test should be inexpensive, well tolerated, and applicable to primary care. Over the past 10 years, significant progress has been made in endoscopic diagnosis and treatment of dysplasia (squamous and Barrett's), and early esophageal cancer using resection and ablation technologies supported by evidence from randomized controlled trials. We review the state-of-the-art technologies for early diagnosis and minimally invasive treatment, which together could reduce the burden of disease.
由于通过内窥镜检查很容易进入食管，因此食管癌的早期诊断和根治性治疗是可行的。然而，由于在肿瘤发展的早期阶段症状不具有特异性，诊断往往会延迟。吞咽困难的出现与晚期疾病有关，其5年生存率低于15%。通过内窥镜进行人群筛查不具有成本效益，但一些替代成像和细胞分析技术正在研究中。理想的筛查测试应该价格低廉、耐受性好且适用于初级保健。在过去10年中，在内窥镜诊断和治疗发育异常（鳞状和巴雷特氏）以及早期食管癌方面取得了重大进展，这些进展采用了随机对照试验证据支持的切除和消融技术。我们回顾了早期诊断和微创治疗的最新技术，这些技术共同作用可以减轻疾病负担。
