| [ Summary ] |
The incidence of Barrett's esophageal (BE) cancer is expected to increase in Japan. Surveillance and early detection of BE cancer has become a critical issue because of the poor 5‒year survival rates for advanced BE cancer. Rigorous surveillance of BE cancer and a systematic biopsy protocol is conducted in the West. Meanwhile, in Japan, detailed observation of Barrett's esophagus with non magnifying and magnifying endoscopy is recommended for surveillance. Acetic acid spraying is also a good method to detect BE cancer, particularly in cases of long-segment Barrett's esophagus. For the treatment of BE cancer, EMR or ablation is mainly conducted in the West, whereas ESD is preferred in Japan. ESD provides larger specimens than does EMR in patients with early Barrett's neoplasia. The ESD procedure is similar to that for lesions in other parts of the gastrointestinal tract. However, the narrow space of the esophagogastric junction and contraction of the lower esophageal sphincter sometimes disturb the visual field and endoscopic control. Skilled endoscope handling, sometimes including retroflexion, is required during ESD for BE cancer. Esophagectomy is the standard treatment for cancers invading into the submucosa or deeper. However, optimal adjuvant treatment is not determined in Japan. |