{"title":"日本Barrett食管相关肿瘤的内镜治疗。","authors":"Yuto Shimamura, Yugo Iwaya","doi":"10.1159/000547645","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Summary: </strong>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.</p><p><strong>Key messages: </strong>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.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-10"},"PeriodicalIF":3.6000,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Endoscopic Management of Barrett's Esophagus and Related Neoplasia in Japan.\",\"authors\":\"Yuto Shimamura, Yugo Iwaya\",\"doi\":\"10.1159/000547645\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Summary: </strong>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.</p><p><strong>Key messages: </strong>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.</p>\",\"PeriodicalId\":11315,\"journal\":{\"name\":\"Digestion\",\"volume\":\" \",\"pages\":\"1-10\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-07-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestion\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000547645\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestion","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000547645","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
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.
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.