Risk factors affecting the Barrett＇smetaplasia-dysplasia-neoplasia sequence

• 作者: Craig S Brown Michael B Ujiki.
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Barrett's ESOPHAGUS Esophageal adenocarcinoma Endoscopy Risk factors RADIOFREQUENCYABLATION ANTIREFLUX surgery
• 年，卷（期）: 2015,（5）
• 页码范围: 438-445
• 页数: 8页
• 分类号: R

摘要

Esophageal adenocarcinoma has the fastest growingincidence rate of any cancer in the United States, andcurrently carries a very poor prognosis with 5 yearsrelative survival rates of less than 15%. Current curativetreatment options are limited to esophagectomy, aprocedure that suffers from high complication ratesand high mortality rates. Metaplasia of the esophagealepithelium, a condition known as Barrett＇s esophagus（BE）, is widely accepted as the precursor lesion foradenocarcinoma of the esophagus. Recently, radiofrequencyablation has been shown to be an effectivemethod to treat BE, although there is disagreement asto whether radio-frequency ablation should be used totreat all patients with BE or whether treatment shouldbe reserved for those at high risk for progressing toesophageal adenocarcinoma while continuing to endoscopicallysurvey those with low risk. Recent researchhas been targeted towards identifying those at greaterrisk for progression to esophageal adenocarcinoma sothat radio-frequency ablation therapy can be used in amore targeted manner, decreasing the total health carecost as well as improving patient outcomes. This reviewdiscusses the current state of the literature regardingrisk factors for progression from BE through dysplasiato esophageal adenocarcinoma, as well as the currentneed for an integrated scoring tool or risk stratificationsystem capable of differentiating those patients athighest risk of progression in order to target theseendoluminal therapies.