Barrett-Ösophagus

Ein Barrett-Ösophagus birgt ein erhöhtes Risiko für die Entwicklung einer intraepithelialen Neoplasie und eines Adenokarzinoms. Die Progression erfolgt über eine niedrig-, dann hochgradige intraepitheliale Neoplasie – daher kommt der Überwachung der Patienten große Bedeutung zu. Dieser Beitrag widmet sich Überwachungsstrategien, der Prävention der malignen Progression sowie der endoskopischen Untersuchung und Therapie beim Barrett-Ösophagus.

Kernaussagen

• Ein Barrett-Ösophagus liegt nur bei Nachweis einer Zylinderepithelmetaplasie-Zunge mit mindestens 10 mm Länge und spezialisiertem Zylinderepithel mit Becherzellen vor.

• Durch das Sprühen von 1,5%iger Essigsäure auf das Barrett-Epithel können frühe Barrett-Neoplasien mit einer hohen Sensitivität und Spezifität detektiert werden.

• Die endoskopische Resektion gefolgt von ablativen Verfahren ist die Therapie der Wahl bei sichtbaren frühen Barrett-Neoplasien.

• Das bevorzugte Ablationsverfahren ist die Radiofrequenzablation.

• Die endoskopische Therapie von T1b-Barrett-Adenokarzinomen ohne Vorliegen von Risikofaktoren ist eine gute Alternative zur Ösophagusresektion.

• Die endoskopische Therapie von frühen Barrett-Neoplasien weist in erfahrenen Händen eine geringe Komplikationsrate auf (Blutungen < 1%, Perforationen < 1%, Stenose 10%).

Schlüsselwörter

Barrett-Ösophagus - gastroösophageale Refluxkrankheit - Adenokarzinom - endoskopische Resektion - Radiofrequenzablation

Publication History

Article published online:
02 December 2020

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