Subscribe to RSS
DOI: 10.1055/a-1466-9727
Barrett-Screening: Rationale, aktuelle Konzepte und Perspektiven
Der Barrett-Ösophagus (BE) stellt den wichtigsten Risikofaktor für das ösophageale Adenokarzinom dar. Derzeit ist kein hinreichend effizientes Screening-Programm verfügbar, um in der Gesamtpopulation Patienten mit einem hohen Risiko für ein ösophageales Adenokarzinom auf dem Boden eines Barrett-Ösophagus zu identifizieren. Das aktuelle endoskopische Screening zielt auf symptomatische Refluxpatienten, aus denen sich aber nur ein Teil der Risikopatienten rekrutiert. Derzeit werden verschiedene neue Verfahren untersucht, die die Effektivität des Screenings deutlich erhöhen könnten.
Selektive Literaturrecherche in MEDLINE/PubMed unter Berücksichtigung deutscher und internationaler Leitlinien.
Alternative Screening-Verfahren könnten zweistufig angelegt sein: Zunächst die Identifikation von Personen „at risk“ über eine Erfassung geeigneter biologischer Marker, dann deren gezielte endoskopisch-bioptische Abklärung, Risikostratifikation, Überwachung (Surveillance) und ggf. Therapie. Neue diagnostische Methoden wie der Cytosponge® in Kombination mit einer Auswertung von Markern für Barrett-Schleimhaut könnten einen wesentlichen Fortschritt darstellen.
Barrett-Karzinome zeigen nach wie vor eine zunehmende Inzidenz und eine (trotz therapeutischer Fortschritte) ungünstige Prognose, wobei aber Patienten mit Barrett-Frühkarzinomen eine gute Prognose hinsichtlich Langzeitüberleben aufweisen. Eine verbesserte Früherkennung ist dringend wünschenswert, da bisher die meisten Patienten erst im fortgeschrittenen Stadium endoskopisch diagnostiziert werden, was eine kurative Therapie erschwert. Nur eine effiziente frühzeitige Identifizierung von Risikopatienten mit Barrett-Ösophagus durch ein praktikables Screening-Programm auf Populationsebene wird zur Verbesserung der Prognose beitragen können.
Publication History
Article published online:
31 May 2021
© 2019. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Giersiepen K, Hense HW, Klug SJ. et al. Planning, implementation and evaluation of cancer screening programs. Z Arztl Fortbild Qualitatssich 2007; 101: 43-49
- 2 Spix C, Blettner M. Screening: part 19 of a series on evaluation of scientific publications. Dtsch Arztebl Int 2012; 109: 385-390 DOI: 10.3238/arztebl.2012.0385.
- 3 Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 1998; 85: 1457-1459 DOI: 10.1046/j.1365-2168.1998.00940.x.
- 4 Sharma P, Dent J, Armstrong D. et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399 DOI: 10.1053/j.gastro.2006.08.032.
- 5 Brierley J, Gospodarowicz M, Wittekind C. UICC TNM classification of malignant tumours. Wiley; 2017
- 6 Robert Koch-Institut. Krebs in Deutschland. Berlin: 2014 9. Ausgabe.
- 7 di Pietro M, Alzoubaidi D, Fitzgerald RC. Barrett’s esophagus and cancer risk: how research advances can impact clinical practice. Gut Liver 2014; 8: 356-370 DOI: 10.5009/gnl.2014.8.4.356.
- 8 Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell 1990; 61: 759-767
- 9 Visrodia K, Singh S, Krishnamoorthi R. et al. Systematic review with meta-analysis: prevalent vs. incident oesophageal adenocarcinoma and high-grade dysplasia in Barrett’s oesophagus. Aliment Pharmacol Ther 2016; 44: 775-784 DOI: 10.1111/apt.13783.
- 10 Nones K, Waddell N, Wayte N. et al. Genomic catastrophes frequently arise in esophageal adenocarcinoma and drive tumorigenesis. Nat Commun 2014; 5: 5224 DOI: 10.1038/ncomms6224.
- 11 Maley CC, Galipeau PC, Li X. et al. The combination of genetic instability and clonal expansion predicts progression to esophageal adenocarcinoma. Cancer Res 2004; 64: 7629-7633 DOI: 10.1158/0008-5472.CAN-04-1738.
- 12 Wang DH, Souza RF. Biology of Barrett’s esophagus and esophageal adenocarcinoma. Gastrointest Endosc Clin N Am 2011; 21: 25-38 DOI: 10.1016/j.giec.2010.09.011.
- 13 Eluri S, Brugge WR, Daglilar ES. et al. The Presence of Genetic Mutations at Key Loci Predicts Progression to Esophageal Adenocarcinoma in Barrett’s Esophagus. Am J Gastroenterol 2015; 110: 828-834 DOI: 10.1038/ajg.2015.152.
- 14 Stachler MD, Taylor-Weiner A, Peng S. et al. Paired exome analysis of Barrett’s esophagus and adenocarcinoma. Nat Genet 2015; 47: 1047-1055 DOI: 10.1038/ng.3343.
- 15 san U, Agency BCC. Cancer Genome Atlas Research N, Analysis Working Group. et al. A. Integrated genomic characterization of oesophageal carcinoma. Nature 2017; 541: 169-175 DOI: 10.1038/nature20805.
- 16 Maley CC, Reid BJ. Natural selection in neoplastic progression of Barrett’s esophagus. Semin Cancer Biol 2005; 15: 474-483 DOI: 10.1016/j.semcancer.2005.06.004.
- 17 Scholvinck DW, van der Meulen K, Bergman J. et al. Detection of lesions in dysplastic Barrett’s esophagus by community and expert endoscopists. Endoscopy 2017; 49: 113-120 DOI: 10.1055/s-0042-118312.
- 18 Behrens A, Pech O, Wuthnow E. et al. Detection of early neoplasia in Barrett’s oesophagus: focus attention on index endoscopy in short-segment-Barrett's oesophagus with random biopsies. Z Gastroenterol 2015; 53: 568-572 DOI: 10.1055/s-0034-1399177.
- 19 Bhat S, Coleman HG, Yousef F. et al. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011; 103: 1049-1057 DOI: 10.1093/jnci/djr203.
- 20 Hvid-Jensen F, Pedersen L, Drewes AM. et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 2011; 365: 1375-1383 DOI: 10.1056/NEJMoa1103042.
- 21 Hamade N, Vennelaganti S, Parasa S. et al. Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett’s Esophagus to Esophageal Adenocarcinoma. Clin Gastroenterol Hepatol 2018; DOI: 10.1016/j.cgh.2018.07.008.
- 22 Pohl H, Pech O, Arash H. et al. Length of Barrett’s oesophagus and cancer risk: implications from a large sample of patients with early oesophageal adenocarcinoma. Gut 2016; 65: 196-201 DOI: 10.1136/gutjnl-2015-309220.
- 23 Reid BJ, Levine DS, 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 DOI: 10.1111/j.1572-0241.2000.02196.x.
- 24 Singh R, Ragunath K, Jankowski J. Barrett’s Esophagus: Diagnosis, Screening, Surveillance, and Controversies. Gut Liver 2007; 1: 93-100 DOI: 10.5009/gnl.2007.1.2.93.
- 25 Spechler SJ, Sharma P. American Gastroenterological A. et al. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology 2011; 140: 1084-1091 DOI: 10.1053/j.gastro.2011.01.030.
- 26 Fitzgerald RC, di Pietro M, Ragunath K. et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 2014; 63: 7-42 DOI: 10.1136/gutjnl-2013-305372.
- 27 Whiteman DC, Appleyard M, Bahin FF. et al. Australian clinical practice guidelines for the diagnosis and management of Barrett’s esophagus and early esophageal adenocarcinoma. J Gastroenterol Hepatol 2015; 30: 804-820 DOI: 10.1111/jgh.12913.
- 28 Koop H, Fuchs KH, Labenz J. et al. S2k guideline: gastroesophageal reflux disease guided by the German Society of Gastroenterology: AWMF register no. 021-013. Z Gastroenterol 2014; 52: 1299-1346 DOI: 10.1055/s-0034-1385202.
- 29 Codipilly DC, Chandar AK, Singh S. et al. The Effect of Endoscopic Surveillance in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis. Gastroenterology 2018; 154: 2068-2086 e2065 DOI: 10.1053/j.gastro.2018.02.022.
- 30 Phoa KN, van Vilsteren FG, Weusten BL. et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA 2014; 311: 1209-1217 DOI: 10.1001/jama.2014.2511.
- 31 Wani S, Falk G, Hall M. et al Patients with nondysplastic Barrett's esophagus have low risks for developing dysplasia or esophageal adenocarcinoma. Clin Gastroenterol Hepatol 2011; 9: 220-227 ; quiz e226. DOI: 10.1016/j.cgh.2010.11.008.
- 32 Kastelein F, van Olphen SH, Steyerberg EW. et al. Impact of surveillance for Barrett's oesophagus on tumour stage and survival of patients with neoplastic progression. Gut 2016; 65: 548-554 DOI: 10.1136/gutjnl-2014-308802.
- 33 Booth CL, Thompson KS. Barrett’s esophagus: A review of diagnostic criteria, clinical surveillance practices and new developments. J Gastrointest Oncol 2012; 3: 232-242 DOI: 10.3978/j.issn.2078-6891.2012.028.
- 34 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 DOI: 10.1056/NEJM199903183401101.
- 35 Solaymani-Dodaran M, Card TR, West J. Cause-specific mortality of people with Barrett's esophagus compared with the general population: a population-based cohort study. Gastroenterology 2013; 144: 1375-1383, 1383 e1371 DOI: 10.1053/j.gastro.2013.02.050.
- 36 Sikkema M, de Jonge PJ, Steyerberg EW. et al Risk of esophageal adenocarcinoma and mortality in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010; 8: 235-244 ; quiz e232. DOI: 10.1016/j.cgh.2009.10.010.
- 37 Gerson LB, Triadafilopoulos G. Screening for esophageal adenocarcinoma: an evidence-based approach. Am J Med 2002; 113: 499-505
- 38 van Putten M, de Vos-Geelen J, Nieuwenhuijzen GAP. et al. Long-term survival improvement in oesophageal cancer in the Netherlands. Eur J Cancer 2018; 94: 138-147 DOI: 10.1016/j.ejca.2018.02.025.
- 39 Gockel I, Gonner U, Domeyer M. et al. Long-term survivors of esophageal cancer: disease-specific quality of life, general health and complications. J Surg Oncol 2010; 102: 516-522 DOI: 10.1002/jso.21434.
- 40 Pech O, Behrens A, May A. et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 2008; 57: 1200-1206 DOI: 10.1136/gut.2007.142539.
- 41 Coletta M, Sami SS, Nachiappan A. et al. Acetic acid chromoendoscopy for the diagnosis of early neoplasia and specialized intestinal metaplasia in Barrett’s esophagus: a meta-analysis. Gastrointest Endosc 2016; 83: 57-67 e51 DOI: 10.1016/j.gie.2015.07.023.
- 42 Chedgy FJQ, Kandiah K, Barr H. et al. Development and validation of a training module on the use of acetic acid for the detection of Barrett’s neoplasia. Endoscopy 2017; 49: 121-129 DOI: 10.1055/s-0042-120179.
- 43 Neumann H, Langner C, Neurath MF. et al. Confocal Laser Endomicroscopy for Diagnosis of Barrett’s Esophagus. Front Oncol 2012; 2: 42 DOI: 10.3389/fonc.2012.00042.
- 44 Iyer PG, Chak A. Can endosheath technology open primary care doors to Barrett’s esophagus screening by transnasal endoscopy?. Endoscopy 2016; 48: 105-106 DOI: 10.1055/s-0034-1393561.
- 45 Gerson L, Lin OS. Cost-benefit analysis of capsule endoscopy compared with standard upper endoscopy for the detection of Barrett’s esophagus. Clin Gastroenterol Hepatol 2007; 5: 319-325 DOI: 10.1016/j.cgh.2006.12.022.
- 46 Younes M, Brown K, Lauwers GY. et al. p53 protein accumulation predicts malignant progression in Barrett’s metaplasia: a prospective study of 275 patients. Histopathology 2017; 71: 27-33 DOI: 10.1111/his.13193.
- 47 Appelman HD, Matejcic M, Parker MI. et al. Progression of esophageal dysplasia to cancer. Ann N Y Acad Sci 2014; 1325: 96-107 DOI: 10.1111/nyas.12523.
- 48 Voltaggio L, Montgomery EA, Lam-Himlin D. A clinical and histopathologic focus on Barrett esophagus and Barrett-related dysplasia. Arch Pathol Lab Med 2011; 135: 1249-1260 DOI: 10.5858/arpa.2011-0019-RA.
- 49 Lyros O, Rafiee P, Nie L. et al. Wnt/beta-Catenin Signaling Activation beyond Robust Nuclear beta-Catenin Accumulation in Nondysplastic Barrett’s Esophagus: Regulation via Dickkopf-1. Neoplasia 2015; 17: 598-611 DOI: 10.1016/j.neo.2015.07.006.
- 50 Pellanda A, Grosjean P, Leoni S. et al. Abrasive esophageal cytology for the oncological follow-up of patients with head and neck cancer. Laryngoscope 1999; 109: 1703-1708 DOI: 10.1097/00005537-199910000-00028.
- 51 Haisley KR, Dolan JP, Olson SB. et al. Sponge Sampling with Fluorescent In Situ Hybridization as a Screening Tool for the Early Detection of Esophageal Cancer. J Gastrointest Surg 2017; 21: 215-221 DOI: 10.1007/s11605-016-3239-3.
- 52 Qiao YL, Wang G. Screening for Esophageal Cancer in China. In: Aziz K, Wu GY. Hrsg Cancer Screening: A Practical Guide for Physicians. Totowa, NJ: Humana Press; 2002: 227-240 DOI: 10.1007/978-1-59259-191-6_14
- 53 Yang H, Berner A, Mei Q. et al. Cytologic screening for esophageal cancer in a high-risk population in Anyang County, China. Acta Cytol 2002; 46: 445-452 DOI: 10.1159/000326859.
- 54 Freeman M, Offman J, Walter FM. et al. Acceptability of the Cytosponge procedure for detecting Barrett’s oesophagus: a qualitative study. BMJ Open 2017; 7: e013901 DOI: 10.1136/bmjopen-2016-013901.
- 55 Tan WK, di Pietro M, Fitzgerald RC. Past, present and future of Barrett’s oesophagus. Eur J Surg Oncol 2017; 43: 1148-1160 DOI: 10.1016/j.ejso.2017.02.004.
- 56 Moinova HR, LaFramboise T, Lutterbaugh JD. et al. Identifying DNA methylation biomarkers for non-endoscopic detection of Barrett’s esophagus. Sci Transl Med 2018; 10 DOI: 10.1126/scitranslmed.aao5848.
- 57 Benaglia T, Sharples LD, Fitzgerald RC. et al. Health benefits and cost effectiveness of endoscopic and nonendoscopic cytosponge screening for Barrett’s esophagus. Gastroenterology 2013; 144: 62-73 e66 DOI: 10.1053/j.gastro.2012.09.060.
- 58 Ross-Innes CS, Debiram-Beecham I, O’Donovan M. et al. Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett’s esophagus: a multi-center case-control study. PLoS Med 2015; 12: e1001780 DOI: 10.1371/journal.pmed.1001780.
- 59 Cancer-Research UK. A trial looking at the Cytosponge test in GP surgeries for people with heartburn symptoms (BEST3). http://wwwcancerresearchukorg/about-cancer/find-a-clinical-trial/a-trial-looking-at-the-cytosponge-test-in-gp-surgeries-for-people-with-heartburn-symptoms-best3#undefined
- 60 Old O, Moayyedi P, Love S. et al. Barrett’s Oesophagus Surveillance versus endoscopy at need Study (BOSS): protocol and analysis plan for a multicentre randomized controlled trial. J Med Screen 2015; 22: 158-164 DOI: 10.1177/0969141315575052.
- 61 Chettouh H, Mowforth O, Galeano-Dalmau N. et al. Methylation panel is a diagnostic biomarker for Barrett’s oesophagus in endoscopic biopsies and non-endoscopic cytology specimens. Gut 2017; DOI: 10.1136/gutjnl-2017-314026.
- 62 Heberle CR, Omidvari AH, Ali A. et al. Cost Effectiveness of Screening Patients With Gastroesophageal Reflux Disease for Barrett’s Esophagus With a Minimally Invasive Cell Sampling Device. Clin Gastroenterol Hepatol 2017; 15: 1397-1404 e1397 DOI: 10.1016/j.cgh.2017.02.017.
- 63 Bus P, Kestens C, Ten Kate FJ. et al. Profiling of circulating microRNAs in patients with Barrett’s esophagus and esophageal adenocarcinoma. J Gastroenterol 2016; 51: 560-570 DOI: 10.1007/s00535-015-1133-5.
- 64 Becker J, May A, Gerges C. et al. The Barrett-associated variants at GDF7 and TBX5 also increase esophageal adenocarcinoma risk. Cancer Med 2016; 5: 888-891 DOI: 10.1002/cam4.641.
- 65 Bohmer AC, Schumacher J. Insights into the genetics of gastroesophageal reflux disease (GERD) and GERD-related disorders. Neurogastroenterol Motil 2017; 29 DOI: 10.1111/nmo.13017.
- 66 Gharahkhani P, Fitzgerald RC, Vaughan TL. et al. Genome-wide association studies in oesophageal adenocarcinoma and Barrett’s oesophagus: a large-scale meta-analysis. Lancet Oncol 2016; 17: 1363-1373 DOI: 10.1016/S1470-2045(16)30240-6.
- 67 Shammas MA. Repetitive sequences, genomic instability and Barrett’s esophageal adenocarcinoma. Mob Genet Elements 2011; 1: 208-212 DOI: 10.4161/mge.1.3.17456.