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Endoscopic diagnosis and treatment of esophageal adenocarcinoma: introduction of Japan Esophageal Society classification of Barrett’s esophagus

机译：食管腺癌的内窥镜诊断和治疗：日本食管学会对Barrett食管的分类介绍

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Endoscopic surveillance of Barrett’s esophagus has become a foundation of the management of esophageal adenocarcinoma (EAC). Surveillance for Barrett’s esophagus commonly involves periodic upper endoscopy with biopsies of suspicious areas and random four-quadrant biopsies. However, targeted biopsies using narrow-band imaging can detect more dysplastic areas and thus reduce the number of biopsies required. Several specific mucosal and vascular patterns characteristic of Barrett’s esophagus have been described, but the proposed criteria are complex and diverse. Simpler classifications have recently been developed focusing on the differentiation between dysplasia and non-dysplasia. These include the Japan Esophageal Society classification, which defines regular and irregular patterns in terms of mucosal and vascular shapes. Cancer invasion depth is diagnosed by endoscopic ultrasonography (EUS); however, a meta-analysis of EUS staging of superficial EAC showed favorable pooled values for mucosal cancer staging, but unsatisfactory diagnostic results for EAC at the esophagogastric junction. Endoscopic resection has recently been suggested as a more accurate staging modality for superficial gastrointestinal cancers than EUS. Following endoscopic resection for gastrointestinal cancers, the risk of metastasis can be evaluated based on the histology of the resected specimen. European guidelines describe endoscopic resection as curative for well- or moderately differentiated mucosal cancers without lymphovascular invasion, and these criteria might be extended to lesions invading the submucosa (≤ 500 μm), i.e., to low-risk, well- or moderately differentiated tumors without lymphovascular involvement, and < 3 cm. These criteria were confirmed by a recent study in Japan.
机译：内窥镜检查巴雷特食管已成为食管腺癌（EAC）处理的基础。对Barrett食道的监视通常包括定期上消化道内窥镜检查，可疑区域活检和随机四象限活检。但是，使用窄带成像的靶向活检可以检测到更多的异常增生区域，从而减少了所需的活检数量。已经描述了巴雷特食管的几种特定的粘膜和血管形态特征，但是提出的标准复杂而多样。最近，针对不典型增生和非典型增生的区别，已经开发出了更简单的分类方法。这些包括日本食管学会分类，该分类根据粘膜和血管形状定义了规则和不规则的模式。癌浸润深度通过内镜超声检查（EUS）诊断；然而，对浅表EAC的EUS分期进行的荟萃分析显示，粘膜癌分期的合并值较高，但在食管胃交界处的EAC诊断结果并不令人满意。最近，内镜切除术被认为是比EUS更准确的浅表胃肠道癌分期方法。内镜切除胃肠道癌后，可根据切除标本的组织学评估转移的风险。欧洲指南将内镜切除术描述为无淋巴管浸润的高分化或中分化粘膜癌的治愈方法，这些标准可能扩展到侵入粘膜下层（≤500μm）的病变，即低危，高分化或中分化的肿瘤而无淋巴管受累，<3 cm。这些标准已在日本的最新研究中得到证实。

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