Barrett食管和食管腺癌的筛查:方法和结果。

IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Natalie J Wilson, Nicholas Mordan, Cole Potrock, Nicholas J Shaheen
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引用次数: 0

摘要

巴雷特食管(BE)是唯一已知的食管腺癌(EAC)的组织学前体。在过去的四十年中,EAC的发病率在美国和其他西方国家显著上升,并且EAC的预后仍然很差,超过一半的患者在晚期才被诊断出来。尽管如此,只有不到五分之一的符合条件的人接受内窥镜检查。目前的筛查方法依赖于上内窥镜检查,限制了广泛采用,并错过了很大一部分高危人群。微创筛查方式的最新技术进步有可能扩大筛查工作,提高检出率,并减少医疗保健资源的利用。本文讨论了成功筛查EAC和BE的概念基础和障碍,评估了筛查的新技术,包括非内窥镜细胞收集装置、基于血液的生物标志物、经鼻内窥镜检查和呼出的挥发性有机化合物,并研究了增强检测不典型增生和肠化生的新方法,包括人工智能和广域经上皮取样。根据英国最近的一项随机监测试验,以及一项具有里程碑意义的BE发育不良非内镜风险分层研究,我们考虑了筛查的价值。虽然缺乏将筛查与降低EAC死亡率联系起来的直接证据,但试验强调了在早期发现癌前病变和癌性病变方面有希望的结果。讨论了优化BE筛选的未来方向、挑战和建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Screening for Barrett Esophagus and Esophageal Adenocarcinoma: Approaches and Outcomes.

Barrett esophagus (BE) is the only known histological precursor to esophageal adenocarcinoma (EAC). The incidence of EAC has risen significantly over the past 4 decades in the United States and other Western countries, and the prognosis of EAC remains poor, with over half of individuals diagnosed at a late stage. Despite this, fewer than 1 in 5 eligible individuals undergo endoscopic screening for BE. Current screening practices rely on upper endoscopy, limiting widespread adoption and missing a significant portion of at-risk individuals. Recent technological advancements in minimally invasive screening modalities have the potential to expand screening efforts, improve detection rates, and reduce healthcare resource utilization. This review discusses the conceptual underpinnings and hurdles to successful screening for EAC and BE, evaluates newer technologies for screening, including nonendoscopic cell collection devices, blood-based biomarkers, transnasal endoscopy, and exhaled volatile organic compounds, and examines emerging methods for enhancing detection of dysplasia and intestinal metaplasia, including artificial intelligence and wide area transepithelial sampling. The value of screening in light of a recent randomized trial of surveillance from the United Kingdom, as well as a landmark study on nonendoscopic risk stratification for dysplasia in BE, are considered. While direct evidence linking screening to reduced EAC mortality is lacking, trials highlight promising outcomes in early detection of precancerous and cancerous lesions. Future directions, challenges, and recommendations for optimizing BE screening are discussed.

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来源期刊
American Journal of Gastroenterology
American Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
11.40
自引率
5.10%
发文量
458
审稿时长
12 months
期刊介绍: Published on behalf of the American College of Gastroenterology (ACG), The American Journal of Gastroenterology (AJG) stands as the foremost clinical journal in the fields of gastroenterology and hepatology. AJG offers practical and professional support to clinicians addressing the most prevalent gastroenterological disorders in patients.
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