Role of endoscopic therapy in early esophageal cancer

被引:30
作者
Malik, Sonika [1 ]
Sharma, Gautam [2 ]
Sanaka, Madhusudhan R. [3 ]
Thota, Prashanthi N. [3 ]
机构
[1] Cleveland Clin, Akron Gen Med Ctr, Dept Internal Med, Akron, OH 44307 USA
[2] Univ Hosp, Dept Anesthesiol, Cleveland, OH 44106 USA
[3] Cleveland Clin, Digest Dis Surg Inst, Dept Gastroenterol, Cleveland, OH 44195 USA
关键词
Endoscopic mucosal resection; Endoscopic submucosal dissection; Radiofrequency ablation; Argon plasma coagulation; Esophageal cancer; Photodynamic therapy; Cryotherapy; HIGH-GRADE DYSPLASIA; SQUAMOUS-CELL CARCINOMA; EARLY-STAGE CANCER; SUBMUCOSAL DISSECTION; MUCOSAL RESECTION; BARRETTS-ESOPHAGUS; RADIOFREQUENCY ABLATION; INTRAEPITHELIAL NEOPLASIA; PHOTODYNAMIC THERAPY; EARLY ADENOCARCINOMA;
D O I
10.3748/wjg.v24.i35.3965
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been significant progress in endoscopic diagnosis and treatment of early stages of cancer using resection and ablation techniques, as shown in several trials in the recent past. Earlier detection of esophageal cancer and advances in treatment modalities have lead to improvement in the 5-year survival from 5% to about 20% in the past decade. Endoscopic eradication therapy is the preferred modality of treatment in cancer limited to mucosal layer of the esophagus as there is very low risk of lymph node metastasis, leading to high cure rates, low risk of recurrence and with few adverse effects. The most common adverse events seen are strictures, bleeding and rarely perforation which can be endoscopically managed. In patients with recurrent advanced disease or invasive tumor, esophagectomy with lymph node dissection remains the mainstay of treatment. There is debate on post-endoscopic surveillance with some studies suggesting closer follow up with upper endoscopy every 6 mo for the first 1-2 years and then annually for the 3 years while others recommending the appropriate action only if symptoms or other abnormalities develop. Overall, the field of endoscopic therapy is still evolving and focus should be placed on careful patient selection using a multidisciplinary approach.
引用
收藏
页码:3965 / 3973
页数:9
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