欧米における早期Barrett食道腫瘍治療の現状

Trends and Current Practices in Endoscopic Treatment of Early Barrett's Esophageal Neoplasia in the West

要旨●早期Barrett食道腫瘍（BEN）に対する欧米の標準治療は，内視鏡で指摘可能な病変の切除と，残存Barrett上皮への焼灼療法の併用である．ESDは正確な病理診断と完全切除が可能である一方，多巣性病変の存在や技術的・制度的制約により適応は限定的である．一方ラジオ波焼灼術（RFA）は高い寛解率と安全性を有し，標準的治療として広く用いられている．近年では凍結療法（cryoablation）やハイブリッドAPCといった新たな補完的手技も導入され，治療選択の幅が拡がっている．これらの治療は，病変の性状や施設の体制に応じて適切に選択されるべきであり，外科治療も含めた包括的な治療が可能な専門施設において，多職種による集学的カンファレンスを通じて行われることが望ましい．BENは欧米において比較的頻度が高いが，すべての内視鏡医が診断・治療に精通しているわけではなく，専門施設での管理が推奨される．

　The standard therapeutic approach for early Barrett's esophageal neoplasia（BEN）in Western countries encompasses endoscopic resection of visible lesions combined with ablation of the remaining Barrett's epithelium. Endoscopic submucosal dissection facilitates accurate histological assessment and en bloc resection ; however, its indications remain limited due to the multifocal nature of BEN and procedural or systemic constraints. Radiofrequency ablation is widely recommended as the standard technique owing to its high efficacy and safety profile. Additional modalities, including cryoablation and hybrid-APC, have recently emerged as complementary alternatives, thereby expanding the spectrum of therapeutic choices. Determining appropriate treatment interventions depends on the lesion characteristics and institutional resources, and they are best performed at specialized centers that can provide comprehensive care, including surgical backup. Although relatively common in the West, accurate diagnosis and treatment of BEN require expertise, and its management at expert centers through multidisciplinary discussions is strongly recommended.