Swathi Eluri MD, MSCR, Nicholas J. Shaheen MD, MPH
{"title":"Barrett食管的内镜根除治疗","authors":"Swathi Eluri MD, MSCR, Nicholas J. Shaheen MD, MPH","doi":"10.1016/j.tgie.2017.06.001","DOIUrl":null,"url":null,"abstract":"<div><p><span><span>Endoscopic eradication therapy<span><span> (EET), the standard of care for treatment of Barrett’s esophagus with </span>dysplasia<span> and early neoplasia, consists of a combination of endoscopic resection and ablative modalities. Resection techniques primarily include </span></span></span>endoscopic mucosal resection<span><span> or endoscopic submucosal dissection. Resection of nodular disease is generally followed by one of multiple </span>ablative therapies among which </span></span>radiofrequency ablation has the best evidence supporting safety and efficacy. These advanced endoscopic procedures require both experience and expertise in the cognitive and procedural aspects of EET. However, very few formal programs exist that teach endoscopists the necessary skills to perform EET in a safe, standardized, and efficacious manner. Case volume at both the endoscopist and center level has been shown to affect clinical outcomes based on limited data. As a result, some recent guidelines endorse case volume as a measure of competency. Quality indicators, which can be used as benchmarks for training and as part of pay for quality initiatives, have recently been derived for EET. However, quality metrics in EET have not been widely accepted, nor are they broadly used currently. Although the efficacy of EET for BE is established, there is a need for application of quality metrics to both assure adequate training in these procedures and assess treatment outcomes. A standardized EET training curriculum during endoscopic training, with competency assessment of both new clinicians and endoscopists in practice, has the potential to improve care in EET.</p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":"19 3","pages":"Pages 137-142"},"PeriodicalIF":0.0000,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2017.06.001","citationCount":"7","resultStr":"{\"title\":\"Endoscopic eradication therapy in Barrett’s esophagus\",\"authors\":\"Swathi Eluri MD, MSCR, Nicholas J. Shaheen MD, MPH\",\"doi\":\"10.1016/j.tgie.2017.06.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p><span><span>Endoscopic eradication therapy<span><span> (EET), the standard of care for treatment of Barrett’s esophagus with </span>dysplasia<span> and early neoplasia, consists of a combination of endoscopic resection and ablative modalities. Resection techniques primarily include </span></span></span>endoscopic mucosal resection<span><span> or endoscopic submucosal dissection. Resection of nodular disease is generally followed by one of multiple </span>ablative therapies among which </span></span>radiofrequency ablation has the best evidence supporting safety and efficacy. These advanced endoscopic procedures require both experience and expertise in the cognitive and procedural aspects of EET. However, very few formal programs exist that teach endoscopists the necessary skills to perform EET in a safe, standardized, and efficacious manner. Case volume at both the endoscopist and center level has been shown to affect clinical outcomes based on limited data. As a result, some recent guidelines endorse case volume as a measure of competency. Quality indicators, which can be used as benchmarks for training and as part of pay for quality initiatives, have recently been derived for EET. However, quality metrics in EET have not been widely accepted, nor are they broadly used currently. Although the efficacy of EET for BE is established, there is a need for application of quality metrics to both assure adequate training in these procedures and assess treatment outcomes. A standardized EET training curriculum during endoscopic training, with competency assessment of both new clinicians and endoscopists in practice, has the potential to improve care in EET.</p></div>\",\"PeriodicalId\":43887,\"journal\":{\"name\":\"Techniques in Gastrointestinal Endoscopy\",\"volume\":\"19 3\",\"pages\":\"Pages 137-142\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2017-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.tgie.2017.06.001\",\"citationCount\":\"7\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Techniques in Gastrointestinal Endoscopy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1096288317300529\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Gastrointestinal Endoscopy","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1096288317300529","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Endoscopic eradication therapy in Barrett’s esophagus
Endoscopic eradication therapy (EET), the standard of care for treatment of Barrett’s esophagus with dysplasia and early neoplasia, consists of a combination of endoscopic resection and ablative modalities. Resection techniques primarily include endoscopic mucosal resection or endoscopic submucosal dissection. Resection of nodular disease is generally followed by one of multiple ablative therapies among which radiofrequency ablation has the best evidence supporting safety and efficacy. These advanced endoscopic procedures require both experience and expertise in the cognitive and procedural aspects of EET. However, very few formal programs exist that teach endoscopists the necessary skills to perform EET in a safe, standardized, and efficacious manner. Case volume at both the endoscopist and center level has been shown to affect clinical outcomes based on limited data. As a result, some recent guidelines endorse case volume as a measure of competency. Quality indicators, which can be used as benchmarks for training and as part of pay for quality initiatives, have recently been derived for EET. However, quality metrics in EET have not been widely accepted, nor are they broadly used currently. Although the efficacy of EET for BE is established, there is a need for application of quality metrics to both assure adequate training in these procedures and assess treatment outcomes. A standardized EET training curriculum during endoscopic training, with competency assessment of both new clinicians and endoscopists in practice, has the potential to improve care in EET.
期刊介绍:
The purpose of each issue of Techniques in Gastrointestinal Endoscopy is to provide a comprehensive, current overview of a clinical condition or surgical procedure in gastrointestinal endoscopy, combining the effectiveness of an atlas with the timeliness of a journal. Each issue places a vigorous emphasis on diagnosis, rationale for and against a procedure, actual technique, management, and prevention of complications. The journal features abundant illustrations, line drawings and color artwork to guide readers through even the most complicated procedure.