Ablation Therapy for Barrett's Esophagus: New Rules for Changing Times.
Ablation Therapy for Barrett's Esophagus: New Rules for Changing Times.
复制标题
DOI：
10.1007/s11894-017-0589-2
复制
发表时间：
2017-08-17
影响因子：
--
通讯作者：
Sharma, Prateek
中科院分区：
文献类型：
--
作者：
Hamade, Nour;Sharma, Prateek
审查目的：在这篇综述中，我们讨论了不同的内镜技术在根除巴雷特食管（BE）以及一些争议领域的treatment.Recent Findings：T1a食管腺癌和BE的高度异型增生的患者应接受内镜消融治疗。迄今为止研究最多的技术是射频消融。对于结节状和扁平状病变，可与内镜粘膜切除术联合使用。到目前为止，冷冻疗法和APC已经显示出良好的疗效和安全性，但还没有成为主流，因为需要更多的研究。由于复发很常见，因此消融后仍需进行监测。低度异型增生可以通过内消融治疗或监测治疗。非异型增生BE的治疗是有争议的，到目前为止，只建议监测。研究正在进行中，以更好地对这些患者进行风险分层。在过去的几年里，我们诊断和治疗BE的能力已经取得了很大的进步，目的是防止其发展为恶性肿瘤。与外科食管切除术相比，内镜技术在根除BE方面的出现提供了一种侵入性更小且更安全的治疗方式。随机试验和大量登记研究的数据为支持这些技术的有效性及其长期耐用性提供了良好的证据。
PURPOSE OF REVIEW: In this review, we discuss different endoscopic techniques in the eradication of Barrett's esophagus (BE) as well as some controversies in the field of treatment.RECENT FINDINGS: Patients with T1a esophageal adenocarcinoma and BE of high-grade dysplasia should undergo endoscopic ablative therapy. The most studied technique to date is radiofrequency ablation. It can be combined with endoscopic mucosal resection in cases containing nodular and flat lesions. Cryotherapy and APC have shown promise with good efficacy and safety profiles so far, but are not mainstream as more studies are needed. Surveillance is still required post-ablation since recurrence is common. Low-grade dysplasia can be treated with either endo-ablative therapy or surveillance. Non-dysplastic BE treatment is controversial and so far, only surveillance is recommended. Research is ongoing to better risk stratify these patients. Our ability to diagnose and treat BE has come a long way in the past few years with the goal of preventing its progression into malignancy. The advent of endoscopic techniques in the eradication of BE has provided a less invasive and safer modality of treatment as compared to surgical esophagectomy. Data in the form of randomized trials and high-volume registries has provided good evidence to support the efficacy of these techniques and their long-term durability.