Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett's esophagus
Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett's esophagus
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DOI：
10.1016/s0016-5107(05)00063-5
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发表时间：
2005-04-01
影响因子：
7.7
通讯作者：
Bergman, JJGHM
中科院分区：
文献类型：
--
作者：
Peters, FR;Kara, MA;Bergman, JJGHM
背景资料：本研究的目的是前瞻性地评估内镜切除术（ER）结合光动力疗法（PDT）治疗选定的患者与早期肿瘤在Barrett食管。方法：患者与Barrett食管和肿瘤病变直径< 2厘米，没有迹象的粘膜下浸润，阳性淋巴结，或远处转移进行诊断ER（帽技术）。切除标本中有T1 sm肿瘤的患者被转诊接受手术; T1 m或侵袭性较低的肿瘤患者接受额外的内镜治疗（ER、PDT和/或氩等离子体凝固[APC]），或对其进行随访。PDT采用5-氨基乙酰丙酸，光剂量100 J/cm 2，λ = 632 nm。结果：33例患者接受了诊断性ER。5例患者未进行内镜治疗，接受了手术（4例T1 sm; 1例，患者偏好）。5名患者立即进入随访方案，23名患者接受了额外的内镜治疗（13名额外的ER，19名PDT，3名APC）。26/28例患者内镜治疗成功;未观察到严重并发症。在随访期间（中位19个月，范围13-24个月），5/26例患者发生了高度异型增生复发：所有患者均成功接受了ER再次治疗。在随访结束时，26/33最初入组的患者（79%）和26/28内镜治疗的患者（93%）是在局部remission.Conclusions：内镜治疗是安全和有效的，为选定的患者与早期肿瘤在巴雷特食管。
Background: The aim of this study was to prospectively evaluate endoscopic resection (ER) combined with photodynamic therapy (PDT) for the treatment of selected patients with early neoplasia in Barrett's esophagus.Methods: Patients with Barrett's esophagus and neoplastic lesions < 2 cm in diameter and no sign of submucosal infiltration, positive lymph nodes, or distant metastasis underwent diagnostic ER (cap technique). Patients with a T1sm tumor in the resection specimen were referred for surgery; those with a T1m or a less invasive tumor underwent additional endoscopic therapy (ER, PDT, and/or argon plasma coagulation [APC]), or they were followed. PDT was performed with 5-aminolevulinic acid and a light dose of 100 J/cm(2) at lambda = 632 nm.Results: Thirty-three patients underwent diagnostic ER. Endoscopic treatment was not performed in 5 patients, who underwent surgery (4 T1sm; 1, patient preference). Five patients were immediately entered into a follow-up protocol, and 23 received additional endoscopic treatment (13 additional ER, 19 PDT, 3 APC). Endoscopic treatment was successful in 26/28 patients; no severe complication was observed. During follow-up (median 19 months, range 13-24 months), 5/26 patients had a recurrence of high-grade dysplasia: all were successfully retreated with ER. At the end of follow-up, 26/33 originally enrolled patients (79%) and 26/28 endoscopically treated patients (93%) were in local remission.Conclusions: Endoscopic therapy is safe and effective for selected patients with early stage neoplasia in Barrett's esophagus.