Surveillance and screening for Barrett esophagus and adenocarcinoma.
Surveillance and screening for Barrett esophagus and adenocarcinoma.
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Barrett 食管和腺癌的监测和筛查。
DOI：
10.1097/01.mcg.0000155859.26557.45
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发表时间：
2005
影响因子：
2.9
通讯作者：
Goyal,RajK
中科院分区：
文献类型：
--
作者：
Mashimo,Hiroshi;Wagh,MihirS;Goyal,RajK
目前对 Barrett 食管及相关病变的筛查和监测的建议是基于美国胃肠病学会实践参数委员会的最新指南。本次审查的目的是批判性地审查这些建议背后的理由和证据。进行强有力的初始测试以记录基线状态并识别早期腺癌以及监测高度不典型增生是有充分理由的。高度不典型增生患者的食管切除术建议需要个体化。然而，监测低度不典型增生和无不典型增生的特殊肠上皮化生的建议主要是意见陈述，没有得到客观数据的充分支持。尽管通过监测发现的癌症比未经事先内窥镜评估诊断的癌症处于早期阶段，但监测失败很常见。筛查和监测的建议没有证据基础，不太可能改变全国食管腺癌的死亡率。它们对个体患者的影响取决于个体情况。目前的建议受到内窥镜检查结果不一致和采样错误、Barrett 食管和发育不良的组织学诊断不一致以及我们对各种组织学病变的自然史了解甚少的限制。未来的方向包括通过体内异常检测和除发育异常分级之外的客观诊断标记（例如DNA含量分析和分子标记）来验证减少这些不一致性的方法，并提高对疾病进展的了解。有效的筛查计划取决于开发简单、廉价且可靠的方法来识别真正处于腺癌高风险的一小部分患者进行内镜筛查。
Current recommendations for screening and surveillance of Barrett esophagus and related lesions are based on recent guidelines by the Practice Parameters Committee of the American College of Gastroenterology. The purpose of this review is to critically examine the rationale and evidence behind these recommendations. There is strong rationale for vigorous initial testing to document the baseline status and identify early adenocarcinoma, and for surveillance of high-grade dysplasia. Recommendations for esophagectomy in patients with high-grade dysplasia need to be individualized. However, recommendations for surveillance of low-grade dysplasia and specialized intestinal metaplasia without dysplasia are largely opinion statements not well supported by objective data. Although cancers identified by surveillance are at earlier stages than those diagnosed without prior endoscopic evaluation, surveillance failures are common. Recommendations for screening and surveillance are not evidence-based and unlikely to alter national mortality from esophageal adenocarcinoma. Their impact on individual patients depends on individual circumstances. Current recommendations are limited by inconsistent endoscopic findings and sampling errors, inconsistent histologic diagnoses of Barrett esophagus and dysplasia, and our poor understanding of the natural history of various histologic lesions. Future directions include validation of methods that reduce these inconsistencies by in vivo detection of abnormalities and by objective diagnostic markers besides grades of dysplasia, such DNA content analysis and molecular markers, and improved understanding of the disease progression. Effective screening programs depend on development of simple, inexpensive, and reliable methods to identify the small group of patients truly at high risk for adenocarcinoma for endoscopic screening.