Medical and endoscopic management of high-grade dysplasia in Barrett's esophagus.
Medical and endoscopic management of high-grade dysplasia in Barrett's esophagus.
复制标题
巴雷特食管高度不典型增生的医学和内镜治疗。
DOI：
10.1111/j.1442-2050.2012.01342.x
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Krishnadath,S
中科院分区：
文献类型：
--
作者：
Wang,KK;Tian,JM;Gorospe,E;Penfield,J;Prasad,G;Goddard,T;Wongkeesong,M;Buttar,NS;Lutzke,L;Krishnadath,S
巴雷特食管高度发育不良的治疗近年来发生了明显的变化。癌症发展的风险仍然很大，大约三分之一的患者会患上癌症，但也有一些患者没有患上癌症。高级别发育不良的性质也已从遗传学上得到阐明，在这一阶段存在比以前认为的更多的染色体不稳定证据。在随机对照试验中，鉴于射频消融和光动力治疗在消除不典型增生和减少癌症发展方面的良好效果，该疾病的治疗已向内窥镜治疗发展。治疗的最佳候选人包括具有相对较短的Barrett食管段、解剖上的直段、缺乏结节性和完整的p16的依从性患者。然而，即使具有与手术切除相似的良好长期效果，仍有超过14%的患者存在复发风险，这表明需要对这些患者继续进行内窥镜检查。
The management of high-grade dysplasia in Barrett’s esophagus has clearly changed over recent years. The risk of cancer development is still substantial, with about one in three patients developing cancer, but a number of patients do not develop cancer. The nature of high-grade dysplasia has also been genetically elucidated with more evidence of chromosomal instability being present at this stage than previously thought. Therapy of the condition has evolved more toward endoscopic therapy, given the good results of radio-frequency ablation and photodynamic therapy in eliminating dysplasia and decreasing cancer development in randomized controlled trial. The best candidates for treatment include compliant patients that have relatively short segments of Barrett’s esophagus, an anatomically straight segment, lack of nodularity, and an intact p16. However, even with excellent long-term results similar to surgical resection, the risk of recurrence is present in over 14% of patients, which indicates that there will be a need to continue surveillance endoscopy in these patients.
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