Old O J, Almond L M, Barr H
Biophotonics Research Unit, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Trust, Gloucester, UK.
Upper GI Surgery Department, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Trust, Gloucester, UK.
Frontline Gastroenterol. 2015 Apr;6(2):108-116. doi: 10.1136/flgastro-2014-100552. Epub 2015 Feb 19.
Endoscopic surveillance remains the core management of non-dysplastic Barrett's oesophagus, although questions regarding its efficacy in reducing mortality from oesophageal adenocarcinoma have yet to be definitively answered, and randomised trial data are awaited. One of the main goals of current research is to achieve risk stratification, identifying those at high risk of progression. The recent British Society of Gastroenterology (BSG) guidelines on surveillance have taken a step in this direction with interval stratification on clinicopathological grounds. The majority of Barrett's oesophagus remains undiagnosed, and this has led to investigation of methods of screening for Barrett's oesophagus, ideally non-endoscopic methods capable of reliably identifying dysplasia. Chemoprevention to prevent progression is currently under investigation, and may become a key component of future treatment. The availability of effective endotherapy means that accurate identification of dysplasia is more important than ever. There is now evidence to support intervention with radiofrequency ablation (RFA) for low-grade dysplasia (LGD), but recent data have emphasised the need for consensus pathology for LGD. Ablative treatment has become well established for high-grade dysplasia, and should be employed for flat lesions where there is no visible abnormality. Of the ablative modalities, RFA has the strongest evidence base. Endoscopic resection should be performed for all visible lesions, and is now the treatment of choice for T1a tumours. Targeting those with high-risk disease will, hopefully, lead to efficacious and cost-effective surveillance, and the trend towards earlier intervention to halt progression gives cause for optimism that this will ultimately result in fewer deaths from oesophageal adenocarcinoma.
内镜监测仍然是非发育异常性巴雷特食管的核心管理方法，尽管关于其在降低食管腺癌死亡率方面的疗效问题尚未得到明确解答，仍有待随机试验数据。当前研究的主要目标之一是实现风险分层，识别出进展风险高的患者。英国胃肠病学会（BSG）近期发布的监测指南已朝着这个方向迈出了一步，即根据临床病理情况进行间隔分层。大多数巴雷特食管仍未被诊断出来，这促使人们对巴雷特食管的筛查方法进行研究，理想的是能够可靠识别发育异常的非内镜方法。目前正在研究预防进展的化学预防方法，其可能会成为未来治疗的关键组成部分。有效的内镜治疗手段的出现意味着准确识别发育异常比以往任何时候都更加重要。现在有证据支持对低级别发育异常（LGD）进行射频消融（RFA）干预，但近期数据强调了LGD的病理诊断需达成共识。消融治疗已被确立用于高级别发育异常，对于无可见异常的扁平病变也应采用。在消融方式中，RFA的证据基础最为充分。对于所有可见病变都应进行内镜切除，目前内镜切除是T1a肿瘤的首选治疗方法。针对高危疾病患者有望实现有效且具有成本效益的监测，而早期干预以阻止疾病进展的趋势让人乐观地认为，这最终将减少食管腺癌导致的死亡人数。
