Hamade Nour, Sharma Prateek
Department of Internal Medicine, University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, MI, USA.
Department of Gastroenterology, Department of Veterans Affairs Medical Center, 4801 E. Linwood Boulevard, Kansas City, MI, 64128, USA.
Curr Gastroenterol Rep. 2017 Aug 17;19(10):48. doi: 10.1007/s11894-017-0589-2.
In this review, we discuss different endoscopic techniques in the eradication of Barrett's esophagus (BE) as well as some controversies in the field of treatment.
Patients with T1a esophageal adenocarcinoma and BE of high-grade dysplasia should undergo endoscopic ablative therapy. The most studied technique to date is radiofrequency ablation. It can be combined with endoscopic mucosal resection in cases containing nodular and flat lesions. Cryotherapy and APC have shown promise with good efficacy and safety profiles so far, but are not mainstream as more studies are needed. Surveillance is still required post-ablation since recurrence is common. Low-grade dysplasia can be treated with either endo-ablative therapy or surveillance. Non-dysplastic BE treatment is controversial and so far, only surveillance is recommended. Research is ongoing to better risk stratify these patients. Our ability to diagnose and treat BE has come a long way in the past few years with the goal of preventing its progression into malignancy. The advent of endoscopic techniques in the eradication of BE has provided a less invasive and safer modality of treatment as compared to surgical esophagectomy. Data in the form of randomized trials and high-volume registries has provided good evidence to support the efficacy of these techniques and their long-term durability.
在本综述中，我们讨论了根除巴雷特食管（BE）的不同内镜技术以及该治疗领域中的一些争议。
T1a期食管腺癌和高级别异型增生的BE患者应接受内镜消融治疗。迄今为止研究最多的技术是射频消融。在包含结节性和平坦病变的病例中，它可与内镜黏膜切除术联合使用。冷冻疗法和氩离子凝固术（APC）目前已显示出良好的疗效和安全性，但由于需要更多研究，尚未成为主流。消融术后仍需进行监测，因为复发很常见。低级别异型增生可采用内镜消融治疗或监测。非异型增生性BE的治疗存在争议，目前仅建议进行监测。正在进行研究以更好地对这些患者进行风险分层。在过去几年中，我们诊断和治疗BE的能力有了很大进步，目标是防止其进展为恶性肿瘤。与手术食管切除术相比，内镜技术在根除BE方面的出现提供了一种侵入性较小且更安全的治疗方式。随机试验和大量登记数据形式的数据为支持这些技术的疗效及其长期耐久性提供了充分证据。
