Al Natour Riad H, Catanzaro A, Zolotarevsky E, DeBenedet Anthony T, Gunaratnam Naresh T
Surgery Department, St Joseph Mercy Health System, 5333 McAuley Drive, Suite RHB-2115, Ann Arbor, MI 48197, USA.
Huron Gastro Center for Digestive Disease, St Joseph Mercy Health System, 5300 Elliott Dr., Ann Arbor, MI 48197, USA.
Dis Esophagus. 2018 Jan 1;31(1):1-6. doi: 10.1093/dote/dox126.
Barrett's esophagus with high-grade dysplasia (BEHGD) and intramucosal esophageal adenocarcinoma (IMC) can be treated by radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR). Efficacy of RFA and EMR in academic medical centers has been demonstrated in previous studies. However, the clinical effectiveness of this approach in community clinical practice is not fully established.All patients with biopsy-proven BEHGD and IMC (T1a), who were treated endoscopically between 2007 and 2014, were prospectively enrolled. Treatment algorithms were determined by consensus opinion after presentation at gastrointestinal tumor board. Patients underwent EMR and/or RFA until eradication-of-dysplasia and complete remission of intestinal metaplasia (CRIM) was achieved. Patients were then enrolled in an endoscopic surveillance program.A total of 60 patients underwent endoscopic therapy for BEHGD (32) or IMC (28). Median length BE was 4 cm. Forty-six patients had EMR. Median treatment interval was nine months. Median follow-up was 33 months (Interquartile range: 16-50). Fifty-five (92%) patients achieved eradication-of-dysplasia and 52(87%) CRIM. One patient with BEHGD did not achieve any benefit six months into treatment. Nine (15%) patients relapsed after CRIM with nondysplastic-BE (6), BE with low-grade dysplasia (1), and BEHGD (2). After retreatment, eradication-of-intestinal metaplasia was achieved in five patients. BE length was a negative predictor for achieving CRIM (OR 0.81; P = 0.04). There were no procedure-related severe complications. Eleven patients with prior EMR developed symptomatic strictures, which were all successfully dilated.Endoscopic management of BEHGD and IMC can be safely and effectively performed in a community clinical practice similarly to high-volume academic medical centers when performed by advanced endoscopists following multidisciplinary approach.
伴有高级别异型增生的巴雷特食管（BEHGD）和黏膜内食管腺癌（IMC）可通过射频消融（RFA）和内镜黏膜切除术（EMR）进行治疗。既往研究已证实RFA和EMR在学术性医学中心的疗效。然而，这种方法在社区临床实践中的临床有效性尚未完全确立。
所有在2007年至2014年间接受内镜治疗的经活检证实为BEHGD和IMC（T1a）的患者均被前瞻性纳入研究。治疗方案在胃肠肿瘤讨论会上经共识确定。患者接受EMR和/或RFA，直至异型增生消除且肠化生完全缓解（CRIM）。然后患者进入内镜监测程序。
共有60例患者接受了针对BEHGD（32例）或IMC（28例）的内镜治疗。BE的中位长度为4厘米。46例患者接受了EMR。中位治疗间隔为9个月。中位随访时间为33个月（四分位间距：16 - 50）。55例（92%）患者实现了异型增生消除，52例（87%）实现了CRIM。1例BEHGD患者在治疗6个月后未获得任何益处。9例（15%）患者在CRIM后复发，复发情况为无异型增生的BE（6例）、低级别异型增生的BE（1例）和BEHGD（2例）。再次治疗后，5例患者实现了肠化生消除。BE长度是实现CRIM的负性预测因素（OR 0.81；P = 0.04）。未发生与操作相关的严重并发症。11例既往接受过EMR的患者出现了有症状的狭窄，均成功进行了扩张。
当由经验丰富的内镜医师采用多学科方法进行操作时，在社区临床实践中对BEHGD和IMC进行内镜管理可像在大型学术性医学中心一样安全有效地进行。
