Article information
Abstract
Periodic endoscopic follow-up is recommended after the diagnosis of Barrett's oesophagus, particularly in patients with dysplasia. The new endoscopic techniques show promising results in identifying areas suspected of housing high grade dysplasia and adenocarcinoma. Endoscopic resection of the mucosa has become a fundamental technique for the complete histological assessment of these lesions and is able to establish appropriate therapeutic decisions. Likewise, this technique may be the therapeutic option in patients with high grade dysplasia and adenocarcinoma, although its application must be complemented with ablation techniques such as radiofrequency to eliminate the residual Barrett's metaplasia. Oesophagectomy associated with lymphadenectomy is the option of choice in patients with submucosal adenocarcinoma. The diagnosis and treatment of patients with early onset high grade dysplasia and adenocarcinoma must be carried out with multidisciplinary teams who can evaluate each case individually. This strategy will enable the oesophagus to be preserved in many patients with high grade dysplasia and indicate oesophagectomy in selected cases.
Keywords:
Barrett's oesophagus
Diagnosis
Treatment
Oesophageal cancer
Resumen
Tras el diagnóstico del esófago de Barrett se recomienda el seguimiento endoscópico periódico, especialmente en pacientes con displasia. Las nuevas técnicas endoscópicas muestran resultados prometedores en la identificación de áreas sospechosas de albergar displasia de alto grado y adenocarcinoma. La resección endoscópica de la mucosa se ha convertido en una técnica fundamental para la valoración histológica completa de estas lesiones y poder establecer decisiones terapéuticas adecuadas. Asimismo, esta técnica puede ser la opción terapéutica en pacientes con displasia de alto grado y adenocarcinoma intramucoso, aunque su aplicación debe complementarse con técnicas ablativas, como la radiofrecuencia, para eliminar la metaplasia de Barrett residual. La esofagectomía combinada con linfadenectomía es la opción de elección en pacientes con adenocarcinoma submucoso. El diagnóstico y el tratamiento de los pacientes con displasia de alto grado y adenocarcinoma precoz deben realizarlos equipos multidisciplinarios que evalúen cada caso de forma individualizada. Esta estrategia permitirá preservar el esófago en muchos pacientes con displasia de alto grado e indicar la esofagectomía en casos seleccionados.
Palabras clave:
Esófago de Barrett
Diagnóstico
Tratamiento
Cáncer de esófago
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