Kernaussagen
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.
Literatur
- 1
Devesa S S, Blot W J, Fraumeni J F jr.
Changing patterns in the incidence of esophageal and gastric carcinoma in the United
States.
Cancer.
1998;
83
2049-2053
- 2
Shaheen N J, Crosby M A, Mozymski E M. et al .
Is there publication bias in the reporting of cancer risk in Barrett’s esophagus.
Gastroenterology.
2000;
119
333-338
- 3
Conio M, Blanchi S, Lapertosa G. et al .
Long-term endoscopic surveillance of patients with Barrett’s esophagus. Incidence
of dysplasia and adenocarcinoma: a prospective study.
Am J Gastroenterol.
2003;
98
1931-1939
- 4
Chak A, Faulx A, Kinnard M. et al .
Identification of Barrett’s esophagus in relatives by endoscopic screening.
Am J Gastroenterol.
2004;
99
2107-2114
- 5 Anderson D M, Keith J. Mosby’s Medical, Nursing, and Allied Health Dictionary, 4th
edn. St. Louis; Mosby-Year Book 1994: 1405
- 6
Gerson L B, Shetler K, Triadafilopoulos G.
Prevalence of Barrett’s esophagus in asymptomatic individuals.
Gastroenterology.
2002;
123
461-467
- 7
Sontag S J, Schnell T, Leya J. et al .
Prevalence of Barrett’s esophagus according to indication for endoscopy: two decades
of accrual.
Gastrointest Endosc.
2002;
55
AB 202
- 8
Connor M J, Weston A, Mayo M S. et al .
Prevalence of Barrett’s esophagus and erosive esophagitis in patients undergoing endoscopy
for dyspepsia.
Gastrointest Endosc.
2002;
55
AB 199
- 9
Rex D K, Cummings O W, Shaw M. et al .
Screening for Barrett’s esophagus in colonoscopy patients with and without heartburn.
Gastroenterology.
2003;
125
1670-1677
- 10
Sampliner R E. Practice Parameters Committee of the American College of Gastroenterology
.
Updated guidelines for the diagnosis, surveillance, and therapy of Barrett’s esophagus.
Am J Gastroenterol.
2002;
97
1888-1895
- 11
Winter C J, Spurlin T J, ChobanianSJ . et al .
Barrett’s esophagus. A prevalent, occult complication of gastroesophageal reflux disease.
Gastroenterology.
1987;
92
1888-1895
- 12
Lagergren J, Bergstrom R, Lindgren A. et al .
Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.
N Engl J Med.
1999;
340
825-831
- 13
Lieberman D A, Oehlke M, Helfand M.
Risk factors for Barrett’s esophagus in community-based practice. GORGE consortium.
Gastroenterology Outcomes Research Group in Endoscopy.
Am J Gastroenterol.
1997;
92
1293-1297
- 14
Nilsson M, Johnsen R, Ye W. et al .
Obesity and estrogen as risk factors for gastroesophageal reflux symptoms.
JAMA.
2003;
290
66-72
- 15
Lagergren J, Weimin Y, Bergstrom R. et al .
Utility of endoscopic screening for upper gastrointestinal adenocarcinoma.
JAMA.
2000;
284
961-962
- 16
Soni A, Sampliner R E, Sonnenberg A.
Screening for high-grade dysplasia in gastroesophageal reflux disease: is it cost-effective?.
Am J Gastroenterol.
2000;
95
2086-2093
- 17
Sharma P, McQuaid K, Dent J. et al .
AGA Chicago Workshop. A critical review of the diagnosis and management of Barrett’s
esophagus: the AGA Chicago Workshop.
Gastroenterology.
2004;
127
310-330
- 18
Ragunath K, Krasner N, Raman V S. et al .
A randomized, prospective cross-over trial comparing methylene blue-directed biopsy
and conventional random biopsy for detecting intestinal metaplasia and dysplasia in
Barrett’s esophagus.
Endoscopy.
2003;
35
998-1003
- 19
Guelrud M, Herrera I, Essenfeld H. et al .
Enhanced magnification endoscopy: a new technique to identify specialized intestinal
metaplasia in Barrett’s esophagus.
Gastrointest Endosc.
2001;
53
559-565
- 20
Preiss C, Charton J P, Schumacher B. et al .
A randomized trial of unsedated transnasal small-caliber esophagogastroduodenoscopy
(EGD) versus peroral small-caliber EGD versus conventional EGD.
Endoscopy.
2003;
35
641-646
- 21
Van Sandick J W, van Lanschot J J, Kuiken B W. et al .
Impact of endoscopic biopsy surveillance of Barrett’s oesophagus on pathological stage
and clinical outcome of Barrett’s carcinoma.
Gut.
1998;
43
216-222
- 22
Corley D A, Levin T R, Habel L A. et al .
Surveillance and survival in Barrett’s adenocarcinomas: a population-based study.
Gastroenterology.
2002;
122
633-640
- 23
Van der Burgh A, Dees J, Hop W C. et al .
Oesophageal cancer is an uncommon cause of death in patients with Barrett’s oesophagus.
Gut.
1996;
39
5-8
- 24
Sharma P, Sidorenko E I.
Are screening and surveillance for Barrett’s oesophagus really worthwhile?.
Gut.
2005;
54(Suppl.1)
i27-i32
- 25
Provenzale D, Schmitt C, Wong J B.
Barrett’s esophagus: a new look at surveillance based on emerging estimates of cancer
risk.
Am J Gastroenterol.
1999;
94
2043-2053
- 26
Sampliner R E.
Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus.
The Practice Parameters Committee of the American College of Gastroenterology.
Am J Gastroenterol.
1998;
93
1028-1032
- 27
Messmann H, Ell C, Fein M. et al .
Gastroösophageale Refluxkrankheit - Ergebnisse einer evidenzbasierten Konsensuskonferenz
der DGVS. Themenkomplex VI: Barrettösophagus.
Z Gastroenterol.
2005;
43
184-190
- 28
Skacel M, Petras R E, Gramlich T L. et al .
The diagnosis of low-grade dysplasia in Barrett’s esophagus and its implications for
disease progression.
Am J Gastroenterol.
2000;
95
3383-3387
- 29
Weston A P, Banerjee S K, Sharma P. et al .
p53 protein overexpression in low grade dysplasia (LGD) in Barrett’s esophagus: immunohistochemical
marker predictive of progression.
Am J Gastroenterol.
2001;
96
1355-1362
- 30
Reid B J, Levine D S, Longton G. et al .
Predictors of progression to cancer in Barrett’s esophagus: baseline histology and
flow cytometry identify low- and high-risk patient subsets.
Am J Gastroenterol.
2000;
95
1669-1676
- 31
Buttar N S, Wang K K, Sebo T J. et al .
Extent of high-grade dysplasia in Barrett’s esophagus correlates with risk of adenocarcinoma.
Gastroenterology.
2001;
120
1630-1639
- 32
Schnell T G, Sontag S J, Chejfec G. et al .
Long-term nonsurgical management of Barrett’s esophagus with high-grade dysplasia.
Gastroenterology.
2001;
120
1607-1619
- 33
Weston A P, Krmpotich P T, Cherian R. et al .
Prospective long-term endoscopic and histological follow-up of short segment Barrett’s
esophagus: comparison with traditional long segment Barrett’s esophagus.
Am J Gastroenterol.
1997;
92
407-413
- 34
Nijhawan P K, Wang K K.
Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy
and high-grade dysplasia within Barrett’s esophagus.
Gastrointest Endosc.
2000;
52
328-332
- 35
Wright T A.
High-grade dysplasia in Barrett’s oesophagus.
Br J Surg.
1997;
84
760-706
- 36
Falk G W, Rice T W, Goldblum J R. et al .
Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett’s esophagus
with high-grade dysplasia.
Gastrointest Endosc.
1999;
49
170-176
- 37
Falk G W, Chittajallu R, Goldblum J R. et al .
Surveillance of patients with Barrett’s esophagus for dysplasia and cancer with balloon
cytology.
Gastroenterology.
1997;
112
1787-1797
- 38
Kara M A, Peters F P, Ten Kate F J. et al .
Endoscopic video autofluorescence imaging may improve the detection of early neoplasia
in patients with Barrett’s esophagus.
Gastrointest Endosc.
2005;
61
679-685
- 39
Reid B J, Levine D S, Longton G. et al .
Predictors of progression to cancer in Barrett’s esophagus: baseline histology and
flow cytometry identify low- and high-risk patient subsets.
Am J Gastroenterol.
2000;
95
1669-1676
- 40
Weston A P, Banerjee S K, Sharma P. et al .
p53 protein overexpression in low grade dysplasia (LGD) in Barrett’s esophagus: immunohistochemical
marker predictive of progression.
Am J Gastroenterol.
2001;
96
1355-1362
- 41
Birkmeyer J D, Siewers A E, Finlayson E V. et al .
Hospital volume and surgical mortality in the United States.
N Engl J Med.
2002;
346
1128-1137
- 42
Barr H, Shepherd N A, Dix A. et al .
Eradication of high-grade dysplasia in columnar-lined (Barrett’s) oesophagus by photodynamic
therapy with endogenously generated protoporphyrin IX.
Lancet.
1996;
348
584-585
- 43
Gossner L, Stolte M, Sroka R. et al .
Photodynamic ablation of high-grade dysplasia and early cancer in Barrett’s esophagus
by means of 5-aminolevulinic acid.
Gastroenterology.
1998;
114
448-455
- 44
Ackroyd R, Brown N J, Davis M F. et al .
Photodynamic therapy for dysplastic Barrett’s oesophagus: a prospective, double blind,
randomised, placebo controlled trial.
Gut.
2000;
47
612-617
- 45
Overholt B F, Panjehpour M, Haydek J M.
Photodynamic therapy for Barrett’s esophagus: follow-up in 100 patients.
Gastrointest Endosc.
1999;
49
1-7
- 46
Overholt B F, Panjehpour M, Halberg D L.
Photodynamic therapy for Barrett’s esophagus with dysplasia and/or early stage carcinoma:
long-term results.
Gastrointest Endosc.
2003;
58
183-188
- 47
Overholt B F, Lightdale C, Wang K. et al .
Photodynamic therapy with porfimer sodium for ablation of high grade dysplasia in
Barrett’s esophagus: international, partially blinded, randomized phase III trial.
Gastrointest Endosc.
2005;
62
488-498
- 48
Ell C, May A, Gossner L. et al .
Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s
esophagus.
Gastroenterology.
2000;
118
670-677
- 49
Van Laethem J L, Jagodzinski R, Peny M O. et al .
Argon plasma coagulation in the treatment of Barrett’s high-grade dysplasia and in
situ adenocarcinoma.
Endoscopy.
2001;
33
257-261
- 50
Pacifico R J, Wang K K, Wongkeesong L M. et al .
Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy
for management of early adenocarcinoma in Barrett’s esophagus.
Clin Gastroenterol Hepatol.
2003;
1
252-257
- 51
Eberl T, Scheubel R, Arnholdt H, Messmann H.
Local endoscopic therapy for intraepithelial high grade neoplasia and early adenocarcinoma
in Barrett’s esophagus.
Gastrointest Endosc.
2005;
61
AB130
- 52
Stein H J, Feith M, Mueller J. et al .
Limited resection for early adenocarcinoma in Barrett’s esophagus.
Ann Surg.
2000;
232
733-742
Prof. Dr. Helmut Messmann
III. Medizinische Klinik
Klinikum Augsburg · Postfach 101920 · 86009 Augsburg
Email: helmut.messmann@klinikum-augsburg.de
