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食管癌的内镜治疗

Endoscopic management of esophageal cancer.

作者信息

Ahmed Osman, Ajani Jaffer A, Lee Jeffrey H

机构信息

Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.

Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.

出版信息

World J Gastrointest Oncol. 2019 Oct 15;11(10):830-841. doi: 10.4251/wjgo.v11.i10.830.

Abstract

Esophageal cancer (EC) generally consists of squamous cell carcinoma (which arise from squamous epithelium) and adenocarcinoma (which arise from columnar epithelium). Due to the increased recognition of risk factors associated with EC and the development of screening programs, there has been an increase in the diagnosis of early EC. Early EC is amenable to curative therapy by endoscopy, which can be performed by either endoscopic resection or endoscopic ablation. Endoscopic resection consists of either endoscopic mucosal resection (preferred in cases of adenocarcinoma) or endoscopic submucosal dissection (preferred in cases of squamous cell carcinoma). Endoscopic ablation can be performed by either radiofrequency ablation, cryotherapy, argon plasma coagulation or photodynamic therapy, amongst others. Endoscopy can also assist in the management of complications post-esophageal surgery, such as anastomotic leaks and perforations. Finally, there is a growing role for endoscopy to manage end-of-life palliative symptoms, especially dysphagia. The growing use of esophageal stents, debulking therapy and dilation can assist in improving a patient's quality of life. In this review, we examine the multiple roles of endoscopy in the management of patients with EC.

摘要

食管癌(EC)通常包括鳞状细胞癌(起源于鳞状上皮)和腺癌(起源于柱状上皮)。由于对与食管癌相关的危险因素的认识增加以及筛查项目的开展,早期食管癌的诊断有所增加。早期食管癌可通过内镜进行根治性治疗,可采用内镜切除或内镜消融。内镜切除包括内镜黏膜切除术(腺癌病例首选)或内镜黏膜下剥离术(鳞状细胞癌病例首选)。内镜消融可通过射频消融、冷冻疗法、氩等离子体凝固或光动力疗法等进行。内镜检查还可辅助食管手术后并发症的处理,如吻合口漏和穿孔。最后,内镜在终末期姑息症状管理中的作用越来越大,尤其是吞咽困难。食管支架、减瘤治疗和扩张术的使用日益增多,有助于改善患者的生活质量。在本综述中,我们探讨了内镜在食管癌患者管理中的多种作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ff6b/6815921/b637c4289c4f/WJGO-11-830-g001.jpg

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