日本Barrett食管相关肿瘤的内镜治疗。

IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Digestion Pub Date : 2025-07-28 DOI:10.1159/000547645
Yuto Shimamura, Yugo Iwaya
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引用次数: 0

摘要

背景:在日本,与西方国家相比,巴雷特食管(BE)相关肿瘤的发病率较低;然而,其发病率正在稳步上升。虽然多模式治疗-典型的内镜切除后消融-是标准的治疗方法,但在日本,内镜切除仍然是主要的治疗策略,主要是由于消融设备的可用性有限。随着内镜技术的进步,内镜下粘膜剥离(ESD)已成为治疗be相关肿瘤的主要方法。这篇综述概述了目前日本的方法,重点是适应症、术前评估、治疗结果和日本临床背景下的切除后监测实践。准确的内窥镜评估,包括使用图像增强模式的放大内窥镜,是日本实践的核心,因为在没有消融治疗的情况下完全切除肿瘤的重要性。虽然日本关于be相关肿瘤的数据仍然相对有限,但几项多中心研究表明,在切除质量、安全性和长期生存方面,特别是在低风险患者中,ESD具有良好的结果。然而,挑战仍然存在,包括缺乏标准化的监测方案,有限的消融途径,以及各机构临床实践的相当大的异质性。日本的监测策略通常依赖于有针对性的活组织检查,而不是系统的随机活组织检查。建立统一的临床途径和循证策略对于解决日本日益增加的be相关肿瘤负担至关重要。·日本BE和食管腺癌(EAC)的发病率正在上升,尽管仍显著低于西方国家。与西方内镜切除与射频消融(RFA)相结合的标准不同,日本的实践主要依赖ESD作为主要的治疗方式。RFA在日本没有广泛应用,导致依赖于完全切除和更积极的内镜切除策略。·监测策略仍然不一致,主要是由于疾病患病率较低和日本特异性临床证据有限。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endoscopic Management of Barrett's Esophagus and Related Neoplasia in Japan.

Background: Barrett's esophagus (BE)-related neoplasia remains less prevalent in Japan than in Western countries; however, its incidence is steadily rising. While multimodal treatment - typically endoscopic resection (ER) followed by ablation - is the standard of care, ER alone remains the primary treatment strategy in Japan. With advances in endoscopic techniques, endoscopic submucosal dissection (ESD) has become the mainstay for managing BE-related neoplasia. This review outlines the current Japanese approach, focusing on indications, preoperative assessment, treatment outcomes, and post-resection surveillance practices within the Japanese clinical context.

Summary: Accurate endoscopic assessment, including the use of magnifying endoscopy with image-enhanced modalities, is central to Japanese practice due to the importance of complete resection of neoplasia in the absence of ablative therapy. While data on BE-related neoplasia remain relatively limited in Japan, several multicenter studies have demonstrated favorable outcomes for ESD in terms of resection quality, safety, and long-term survival, particularly in low-risk patients. However, challenges remain, including the lack of standardized surveillance protocols and considerable heterogeneity in clinical practice across institutions. The establishment of unified clinical pathways and evidence-based strategies will be essential to address the increasing burden of BE-related neoplasia in Japan.

Key messages: The incidence of BE and esophageal adenocarcinoma is increasing in Japan, although still significantly lower than in Western countries. Unlike the Western standard of combining ER with radiofrequency ablation (RFA), Japanese practice relies primarily on ESD as the main curative modality. RFA is not widely available in Japan, leading to a reliance on complete resection and more aggressive ER strategies. Surveillance strategies remain inconsistent, largely due to the lower disease prevalence and limited Japan-specific clinical evidence.

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来源期刊
Digestion
Digestion 医学-胃肠肝病学
CiteScore
7.90
自引率
0.00%
发文量
39
审稿时长
6-12 weeks
期刊介绍: ''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.
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