Riegler M, Kristo I, Nikolic M, Rieder E, Schoppmann S F
Reflux Medical Vienna, Vienna, Austria.
Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center, GET-Unit, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
Eur Surg. 2017;49(6):282-287. doi: 10.1007/s10353-017-0504-y. Epub 2017 Dec 4.
Barrett's esophagus (BE) is the premalignant manifestation of gastroesophageal reflux disease (GERD). Radiofrequency ablation (RFA) with and without endoscopic resection (ER) is a novel treatment for BE.
Here we present a single-center update of the recommendations of a recent (June 2015) interdisciplinary expert panel meeting on the management of BE with dysplasia as well as cancer-positive and cancer-negative BE. We conducted a PubMed search of studies published in 2016 and 2017 on the topic of BE and RFA.
Our update reconfirms that BE positive for T1a cancer as well as low- and high-grade dysplasia justifies the use of RFA ± ER, offering an 80-100% rate of BE clearance. RFA ± ER of dysplastic BE is tenfold more effective for cancer prevention when compared with surveillance. Risk factors for recurrence and follow-up treatments include baseline histopathology (dysplasia/T1a cancer), esophagitis, hiatal hernia >3 cm, smoking habits, BE segments >3 cm, and >10 years of GERD symptoms. A baseline diagnosis for dysplasia and T1a cancer should include a second expert pathologist opinion. Recent data justify the use of RFA for nondysplastic BE only in controlled clinical trials. Antireflux surgery can be offered to those with function-test-proven, GERD-symptom-positive BE before, during, or after RFA ± ER. Additionally, there is growing evidence that the intake of a sugar-rich diet is positively correlated with the development of GERD, BE, and cancer.
RFA ± ER should be offered for dysplastic BE and T1a cancer after ER as well as for nondysplastic BE with additional risk factors in controlled trials. Antireflux surgery can be offered to patients with function-test-proven GERD-symptom-positive BE. Diet considerations should be included in the management of GERD and BE.
巴雷特食管（BE）是胃食管反流病（GERD）的癌前表现。联合或不联合内镜切除术（ER）的射频消融术（RFA）是治疗BE的一种新方法。
在此，我们展示了一个单中心对近期（2015年6月）关于异型增生性BE以及癌阳性和癌阴性BE管理的跨学科专家小组会议建议的更新内容。我们对2016年和2017年发表的关于BE和RFA主题的研究进行了PubMed检索。
我们的更新再次证实，T1a期癌阳性以及低级别和高级别异型增生的BE有理由使用RFA±ER，BE清除率为80% - 100%。与监测相比，异型增生性BE的RFA±ER在预防癌症方面效果要高十倍。复发和后续治疗的风险因素包括基线组织病理学（异型增生/T1a期癌）、食管炎、食管裂孔疝>3 cm、吸烟习惯、BE段>3 cm以及GERD症状持续>10年。异型增生和T1a期癌的基线诊断应包括第二位专家病理学家的意见。近期数据表明，仅在对照临床试验中RFA可用于非异型增生性BE。对于在RFA±ER之前、期间或之后经功能测试证实有GERD症状阳性的BE患者，可提供抗反流手术。此外，越来越多的证据表明，高糖饮食的摄入与GERD、BE和癌症的发生呈正相关。
对于异型增生性BE和ER后T1a期癌以及对照试验中有额外风险因素的非异型增生性BE，应提供RFA±ER。对于经功能测试证实有GERD症状阳性的BE患者，可提供抗反流手术。GERD和BE的管理应考虑饮食因素。
