What is the optimal surveillance strategy for non-dysplastic Barrett's esophagus?
What is the optimal surveillance strategy for non-dysplastic Barrett's esophagus?
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DOI：
10.1007/s11938-020-00297-9
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Iyer PG
中科院分区：
文献类型：
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作者：
Gibbens Y;Iyer PG
目前推荐的内镜监测策略在非异型增生BE患者中的有效性存在相互矛盾的数据。我们回顾了文献，以评估目前的监测策略的（成本）效益。我们还回顾了可以提高异型增生检测的关键策略和新技术。对当前EGD监测指南的依从性不佳，漏诊异型增生/EAC的比率较高。监测对EAC死亡率的影响似乎不大。使用高分辨率仔细清洁、检查和取样BE粘膜，同时进行光和（电子）色素内镜检查至关重要。较新的取样技术加上计算机辅助诊断和新兴的成像技术，在改善发育异常检测方面显示出了希望。基于进展风险因素的风险分层的个性化监测可能即将到来。目前的BE监测策略可能会通过组织采样、先进成像和风险分层方面的新兴新技术进一步完善和优化。
There is conflicting data on the effectiveness of the currently recommended endoscopic surveillance strategy in non-dysplastic BE patients. We reviewed the literature to evaluate the (cost) effectiveness of the current surveillance strategy. We also reviewed critical strategies and new technologies which could improve dysplasia detection. Adherence to the current EGD surveillance guidelines is suboptimal with high rates of missed dysplasia/EAC. The influence of surveillance on EAC mortality appears modest. Careful cleansing, inspection and sampling of the BE mucosa using high resolution while light and (electronic) chromoendoscopy is critical. Newer sampling techniques coupled with computer aided diagnosis and emerging imaging technologies have shown promise in improving dysplasia detection. Personalized surveillance with risk stratification based on risk factors for progression may be on the horizon. Current BE surveillance strategy will likely be further refined and optimized by emerging new technologies in tissue sampling, advanced imaging and risk stratification.