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Gastroenterologie up2date 2006; 2(3): 183-192
DOI: 10.1055/s-2006-944674
Ösophagus/Magen/Duodenum
© Georg Thieme Verlag KG Stuttgart · New York

Barrett-Ösophagus - Diagnostik und Therapie

Helmut  Messmann
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Publication History

Publication Date:
20 September 2006 (online)

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Definition und Diagnose

Die Verdachtsdiagnose eines Barrett-Ösophagus wird endoskopisch gestellt, muss aber immer histologisch bestätigt werden (intestinalisiertes metaplastisches Zylinderepithel, intestinale Metaplasie Typ III). Dazu werden aus der verdächtigen Region alle 1 - 2 cm 4-Quadranten-Biopsien entnommen.

Screening und Überwachung

Intraepitheliale Neoplasien sind der wesentliche Risikofaktor für die Entstehung eines Barrett-Adenokarzinoms.

Eine Überwachung ist nur sinnvoll bei Patienten, bei denen die Entdeckung von IEN/Karzinomen eine klinische Konsequenz nach sich zieht.

Goldstandard des Screenings und der Überwachung ist nach wie vor die Videoendoskopie mit 4-Quadranten-Biopsie in Abständen von 1 - 2 cm, allerdings sind Screening-Endoskopien zur Detektion eines Barrett-Ösophagus nicht wissenschaftlich belegt.

Management von IEN und Frühkarzinomen

Die endoskopische Therapie (photodynamische Therapie, endoskopische Resektion) von IEN und Frühkarzinomen ist im Vergleich zur Operation offensichtlich gleich effektiv, aber nebenwirkungsärmer und mit geringerer Mortalität und Morbidität vergesellschaftet, so dass sie sich wohl zur Methode der Wahl entwickeln wird.

Bei Infiltration in die Submukosa sollte in jedem Fall die Operation die Methode der Wahl sein, da hier bereits in bis zu 20 % Lymphknotenmetastasen vorliegen.

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Prof. Dr. Helmut Messmann

III. Medizinische Klinik

Klinikum Augsburg · Postfach 101920 · 86009 Augsburg

Email: helmut.messmann@klinikum-augsburg.de

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