Barrett食管的内镜根除治疗

Swathi Eluri MD, MSCR, Nicholas J. Shaheen MD, MPH
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引用次数: 7

摘要

内镜根除疗法(EET)是治疗Barrett食管发育不良和早期肿瘤的标准治疗方法,包括内镜切除和消融相结合的治疗方式。切除技术主要包括内镜下粘膜切除或内镜下粘膜剥离。结节性疾病切除后通常采用多种消融治疗中的一种,其中射频消融的安全性和有效性得到最充分的证据支持。这些先进的内窥镜手术需要在EET的认知和程序方面的经验和专业知识。然而,很少有正式的项目教内窥镜医生以安全、标准化和有效的方式执行EET的必要技能。基于有限的数据,内镜医师和中心水平的病例量已被证明会影响临床结果。因此,最近的一些指导方针支持将案例数量作为能力的衡量标准。最近为EET制定了质量指标,这些指标可以作为培训的基准,也可以作为质量计划的一部分。然而,EET中的质量度量并没有被广泛接受,也没有被广泛使用。虽然EET治疗BE的有效性已经确定,但仍需要应用质量指标来确保这些程序的充分培训和评估治疗结果。内窥镜培训期间标准化的EET培训课程,以及对新临床医生和内窥镜医师在实践中的能力评估,有可能改善EET的护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Endoscopic eradication therapy in Barrett’s esophagus

Endoscopic eradication therapy in Barrett’s esophagus

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.

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来源期刊
Techniques in Gastrointestinal Endoscopy
Techniques in Gastrointestinal Endoscopy GASTROENTEROLOGY & HEPATOLOGY-
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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.
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