Follow-up and treatment principles of esophageal precancerous lesions

Esophageal precancerous lesions are abnormal changes in esophageal cells before they become cancerous, mainly including esophageal squamous cell dysplasia and Barrett's esophagus dysplasia. Although these lesions have not yet developed into cancer, they may gradually develop into malignant tumors if not intervened in time. Therefore, understanding their follow-up and treatment principles is of great significance for the prevention of esophageal cancer.

1. Follow-up and treatment of esophageal squamous cell dysplasia

Follow-up principles for low-grade intraepithelial neoplasia

For patients with low-grade intraepithelial neoplasia, it is recommended to undergo endoscopic examination every 1 to 3 years to observe the development of the lesion. This regular follow-up helps to detect the progression of the lesion in a timely manner so that appropriate treatment measures can be taken.

Management of low-grade intraepithelial neoplasia with high-risk factors or large lesions

When low-grade intraepithelial neoplasia is combined with high-risk factors under endoscopy or the long diameter of the lesion is greater than 1 cm, we should be vigilant and undergo endoscopy once a year for 5 years. Such intensive follow-up helps doctors more accurately assess the risk of lesions and make corresponding treatment decisions.

Management of low-grade combined with high-grade lesions or pathological upgrade

Endoscopic resection is recommended for patients with low-grade intraepithelial neoplasia combined with high-grade lesions or with pathological upgrade risk factors. If resection is not possible for various reasons, endoscopy should be repeated within 3 to 6 months and biopsy should be performed again. For cases where en bloc resection is difficult or the patient cannot tolerate endoscopic resection, radiofrequency ablation can be considered.

Endoscopic resection and radiofrequency ablation of high-grade intraepithelial neoplasia

For patients with high-grade intraepithelial neoplasia and no submucosal invasion and lymph node metastasis by endoscopic or imaging assessment, endoscopic en bloc resection is the first choice. Similarly, for cases where en bloc resection is difficult or the patient cannot tolerate endoscopic resection, radiofrequency ablation can be considered.

II. Follow-up and treatment of Barrett's esophageal dysplasia

Follow-up recommendations for Barrett's esophagus without dysplasia

For patients with Barrett's esophagus without dysplasia, the guidelines recommend an endoscopic examination every 3 to 5 years. This follow-up period helps doctors to detect and treat possible dysplastic lesions in a timely manner.

Radiofrequency ablation and follow-up of low-grade dysplastic Barrett's esophagus

For patients with Barrett's esophagus and low-grade mucosal dysplasia, the guidelines recommend endoscopic radiofrequency ablation. For patients who do not receive treatment, follow-up should be performed every 6 to 12 months to detect and treat possible lesion progression in a timely manner.

Endoscopic resection and radiofrequency ablation of high-grade dysplastic Barrett's esophagus

For patients with Barrett's esophagus and high-grade dysplasia, endoscopic resection followed by radiofrequency ablation is the first choice. Such a comprehensive treatment plan helps to more effectively reduce the risk of esophageal cancer.

In short, regular follow-up and timely treatment intervention can effectively reduce the risk of esophageal precancerous lesions progressing to cancer. Therefore, it is recommended that the general public undergo regular physical examinations and pay attention to esophageal health. Once esophageal precancerous lesions are found, they should receive professional treatment as soon as possible.