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Endoscopic assessment and management of early esophageal adenocarcinoma

查看全文 作　　者：Ghassan M [1]Hammoud;Hazem [1]Hammad;Jamal A [1]Ibdah 高影响力作者 机构地区：[1]Division of Gastroenterology and Hepatology, University of Mis-souri, Columbia, MO 65212, United States高影响力机构 出　　处：《World Journal of Gastrointestinal Oncology》索引2014年第6卷第8期,共14页高影响力期刊 摘　　要：Esophageal carcinoma affects more than 450000people worldwide and the incidence is rapidly increasing.In the United States and Europe,esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence.Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages.Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett’s esophagus.These risk factors include chronic gastroesophageal reflux disease,hiatal hernia,advanced age,male sex,white race,cigarette smoking,and obesity.The annual risk of esophageal cancer is approximately 0.25%for patients without dysplasia and 6%for patients with high-grade dysplasia.Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa.The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option.The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia.Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation,photodynamic therapy and cryoablation.Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion.Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor,positive lymph node and submucosal invasion.Surgical resection should be offered to patients with deep submucosal invasion. 关 键 词：Esophageal adenocarcinoma High grade dysplasia,endoscopic ultrasound GASTROESOPHAGEAL REFLUX Barrett’s esophagus CHROMOENDOSCOPY Narrow band imaging ENDOSCOPIC MUCOSAL resection Radiofrequency ablation
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