今天的错误和明天的智慧——在巴雷特的监视中。

IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Visceral Medicine Pub Date : 2022-06-01 DOI:10.1159/000522376
Pauline A Zellenrath, Carlijn A M Roumans, Manon C W Spaander
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引用次数: 1

摘要

背景:Barrett食管(BE)是已知的唯一一种食管腺癌的前体病变,是一种发病率不断上升、生存率较低的恶性肿瘤。为了降低死亡率,建议对BE患者进行定期内镜检查,以在内镜下可治愈的阶段发现肿瘤。在这篇综述中,我们旨在概述当前的BE监测策略,其缺陷,以及优化BE监测的潜在未来方向。总结:一些社会准则提供了监测策略。然而,在实践这些内窥镜检查时,遇到了许多缺点。重要的挑战是耗时的活检方案,低依从率,活检取样错误,内镜下检测病变的观察者之间的差异,以及诊断不典型增生的观察者之间的差异。此外,监测的总体功效和成本效益也受到质疑。使用新的技术,如人工智能和个性化的监测间隔,可以帮助克服这些障碍。关键信息:目前,BE监测有改进的余地。更好的风险分层预计将减轻患者和医疗保健负担。个性化和动态监测间隔伴随着新技术的检测和组织病理学评估的不典型增生可能是正确的方向改变的工具。
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Today's Mistakes and Tomorrow's Wisdom… In Barrett's Surveillance.

Background: Barrett's esophagus (BE) is the only known precursor lesion of esophageal adenocarcinoma, a malignancy with increasing incidence and poor survival rates. To reduce mortality, regular endoscopic surveillance of BE patients is recommended to detect neoplasia in an (endoscopically) curable stage. In this review, we aim to provide an overview of current BE surveillance strategies, its pitfalls, and potential future directions to optimize BE surveillance.

Summary: Several societal guidelines provide surveillance strategies. However, when practicing those endoscopies multiple drawbacks are encountered. Important challenges are time-consuming biopsy protocols with low adherence rates, biopsy sampling error, interobserver variability in endoscopic detection of lesions, and interobserver variability in diagnosis of dysplasia. Furthermore, the overall efficacy and cost-effectiveness of surveillance are questioned. Using novel techniques, such as artificial intelligence and personalized surveillance intervals, can help to overcome these obstacles.

Key messages: Currently, there is room for improvement in BE surveillance. Better risk-stratification is expected to reduce both patient and healthcare burdens. Personalized and dynamic surveillance intervals accompanied by novel techniques in detection and histopathological assessment of dysplasia may be tools for a change in the right direction.

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来源期刊
Visceral Medicine
Visceral Medicine Medicine-Surgery
CiteScore
4.50
自引率
0.00%
发文量
40
期刊介绍: This interdisciplinary journal is unique in its field as it covers the principles of both gastrointestinal medicine and surgery required for treating abdominal diseases. In each issue invited reviews provide a comprehensive overview of one selected topic. Thus, a sound background of the state of the art in clinical practice and research is provided. A panel of specialists in gastroenterology, surgery, radiology, and pathology discusses different approaches to diagnosis and treatment of the topic covered in the respective issue. Original articles, case reports, and commentaries make for further interesting reading.
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