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Endoscopic mucosal resection in the upper gastrointestinal tract

World Journal of Gastroenterology 2008年第13期14卷 1984-1989页

作者： anis ahmadi Peter Draganov Division Gastroenterology Hepatology and Nutrition University of Florida Gainesville Florida 32610 United States

Endoscopic mucosal resection （EMR） is a technique used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally described as a therapy for early gastric cancer. Recently its use has expanded as a therapeutic option for ampullary masses, colorectal cancer, and large colorectal polyps. In the Western world, the predominant indication for EMR in the upper gastrointestinal tract is the staging and treatment of advance dysplasia and early neoplasia in Barrett＇s esophagus. This review will describe the basis, indications, techniques, and complications of EMR, and its role in the management of Barrett＇s esophagus.

关键词： Endoscopic mucosal resection Mucosal resection Barrett's esophagus Barrett's dysplasia Therapeutic endoscopy

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Colorectal cancer surveillance in inflammatory bowel disease: The search continues

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World Journal of Gastroenterology 2009年第1期15卷 61-66页

作者： anis ahmadi Steven Polyak Peter V Draganov Department of Gastroenterology Hepatology and Nutrition University of Florida1600 SW Archer Rd Room HD 602 PO Box 100214 Gainesville Florida 32610 United States

Patients with infl ammatory bowel disease (IBD) are at increased risk for colorectal cancer (CRC). Risk factors for the development of CRC in the setting of IBD include disease duration, anatomic extent of disease, age at time of diagnosis, severity of inflammation, family history of colon cancer, and concomitant primary sclerosing cholangitis. The current surveillance strategy of surveillance colonoscopy with multiple random biopsies most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately, surveillance colonoscopy also has severe limitations including high cost, sampling error at time of biopsy, and interobserver disagreement in histologically grading dysplasia. Furthermore, once dysplasia is detected there is disagreement about its management. Advances in endoscopic imaging techniques are already underway, and may potentially aid in dysplasia detection and improve overall surveillance outcomes. Management of dysplasia depends predominantly on the degree and focality of dysplasia, with the mainstay of management involving either proctocolectomy or continued colonoscopic surveillance. Lastly, continued research into additional chemopreventive agents may increase our arsenal in attempting to reduce the incidence of IBD-associated CRC.

关键词： Colorectal cancer Crohn's disease Inflammatory bowel disease Surveillance colonoscopy Ulcerative colitis

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