1, definition
Barrett's esophagus (BE), also known as Barrett's esophagus, means that the squamous epithelium of the lower esophagus is covered by columnar epithelium. In recent 25 years, the incidence of gastroesophageal reflux disease and esophageal adenocarcinoma has increased significantly. At present, it is generally believed that BE is related to GORD and may cause adenocarcinoma, which is a precancerous lesion of esophageal adenocarcinoma.
In recent years, basic research has focused on discovering the mechanism of the occurrence, development (atypical hyperplasia) and malignant transformation of BE. Clinical research focuses on the risk of BE progression, the susceptible factors of tumor occurrence and the discovery of precancerous indicators.
2. the mechanism of 2.BE
At present, it is generally believed that BE is an acquired phenomenon of severe gastroesophageal reflux, and intestinal metaplasia secreted by mucus is often considered as an adaptive and protective response to reflux substances. However, under the influence of reflux substances (acid, enzyme and duodenal juice), which cells develop into cells is still controversial.
3. Development of Business English
It is estimated that the true incidence of BE is about 65438 0.5%. Most BE can remain stable for life, and only 65,438+0% turn into low-grade atypical hyperplasia every year. At the same time, based on the following two points, low-grade atypical hyperplasia is considered relatively harmless:
1. Less than 2% of low-grade atypical hyperplasia turns into high-grade atypical hyperplasia every year;
2. Many endoscopic biopsies show that low-grade atypical hyperplasia may be reversed to simple metaplasia.
However, a recent evidence shows that the true ratio of low-grade atypical hyperplasia to high-grade atypical hyperplasia may be higher, about 9% every year, mainly because some atypical hyperplasia patients are misdiagnosed as low-grade atypical hyperplasia, so the accurate classification of atypical hyperplasia is particularly important.
4. Endoscopic intervention.
With the deepening of people's understanding of high-grade atypical hyperplasia and tumor risk, endoscopic technology has developed rapidly, and more and more auxiliary means have been applied to esophageal endoscopy, such as dye spraying, spontaneous fluorescence, narrow-band imaging, magnifying endoscopy and Raman spectroscopy, molecular pathology and so on.
At the initial stage of endoscopic application, atypical hyperplasia is usually treated by thermal ablation, usually combined with proton pump inhibitor or occasionally combined with anti-reflux surgery. However, there is no effective evidence to prove that the proliferative site was completely removed after operation.
At the end of 1990s, endoscopic mucosal resection developed rapidly. EMR can remove abnormal hyperplasia epithelium and effectively reverse metaplasia mucosa, thus achieving the purpose of treating and preventing the recurrence of BE.
Radio frequency ablation (RFA), as a minimally invasive method to treat BE, uses high frequency radio frequency waves to destroy esophageal endothelial cells, resulting in thermal damage. When the abnormal cells or precancerous cells of esophageal endothelium are destroyed, the normal tissues in the original position can be regenerated and repaired. Studies have shown that RFA can remove about 90% of the residual hyperplastic epithelium.
As far as the current follow-up results are concerned, RFA and EMR have good therapeutic effect and low risk, and low-grade atypical hyperplasia does have its risks. So can the above methods BE used in be stage?
Recent evidence shows that the above intervention in BE stage is probably reasonable, but there are still some risks. In a recent randomized trial, the risk of recurrence 3 years after RFA was only 65,438 0.5%, which was significantly lower than that of the control group (26.5%). At the same time, the incidence of mucosal cancer in the treatment group was only 65438 0.5%, which was significantly lower than that in the control group (8.8%). However, endoscopic review is still recommended to monitor the recurrence of BE.
5. Endoscopic interventional therapy for early esophageal cancer.
At present, the detection rate of early esophageal cancer has been significantly improved through the wide application of endoscopic monitoring, the improvement of endoscopic imaging technology, the application of molecular pathological methods and the standardization of endoscopic evaluation.
EMR has become an effective method to treat early esophageal cancer. Before EMR, it is necessary to locate the tumor accurately to ensure that the tumor can be removed in a sufficient range and depth. The curative effect should still be monitored by endoscope after operation.
About 20% of patients whose tumor has invaded submucosa may have lymph node metastasis. The risk of lymph node metastasis can be predicted by the depth of tumor invasion, but it is still controversial. At the same time, the pathological features of primary tumor (degree of differentiation and lymphatic infiltration) and the genetic composition of patients are also related to lymph node metastasis. Sentinel lymph node biopsy technique can be used as a means to judge whether esophagectomy is performed.
To sum up, the intervention measures of esophageal endoscope are being widely used in BE and different stages of early esophageal cancer. Surgeons should constantly improve their understanding of endoscopic adverse events, postoperative monitoring and prognostic factors. Although the curative effect of long-term intervention still needs more reliable evidence, endoscopic treatment is still worth recommending at present.
6. Treatment of esophageal cancer
1, surgical treatment. Experts believe that the most common treatment is surgery, which is also a common treatment in the treatment of esophageal cancer. Early surgical treatment of esophageal cancer is more effective, but surgical treatment will cause certain harm to the patient's body, so it must be used with caution.
2. Radiotherapy. It mainly includes external irradiation and intracavitary irradiation, and preoperative and postoperative radiotherapy has little damage to patients. Chemotherapy, as an auxiliary treatment of surgery or radiotherapy, is used in combination with other treatments, and the effect is quite good.
3. Chinese medicine treatment. This is also a common treatment for esophageal cancer. Traditional Chinese medicine treatment has little side effects on patients and fundamentally treats diseases. Therefore, in the treatment of esophageal cancer, Chinese medicine treatment is very popular with everyone. However, when choosing the treatment method, it is necessary to carry out targeted treatment according to the patient's own symptoms, so that the treatment can be effective.
The treatment of esophageal cancer is generally divided into western medicine and traditional Chinese medicine, and western medicine can be divided into radiotherapy, chemotherapy, surgery and other methods. Each method has certain indications, and surgical treatment is only suitable for early treatment. However, esophageal cancer is generally found in the late stage. At this time, Chinese medicine can make up for the deficiency of western medicine, give full play to the advantages of Chinese medicine and bring good news to patients.