Update Barrett-Ösophagus

Das Thema Barrett-Ösophagus begleitet uns bereits geraume Zeit im klinischen Alltag. In den 70er-Jahren wurde der Zusammenhang mit dem gastroösophagealen Reflux erkannt, 10 Jahre später mit dem Adenokarzinom des Ösophagus. Ab den 90er-Jahren nahm das Thema Barrett-Ösophagus rasant an Fahrt auf. Die endoskopischen Möglichkeiten in Diagnostik und Therapie entwickelten sich schnell weiter. Patienten mit einem Barrett-Ösophagus werden heute individualisiert überwacht und therapiert. Aktuell wird das diagnostische Spektrum durch die faszinierenden Möglichkeiten der künstlichen Intelligenz erweitert.

Abstract

Barrett’s esophagus has been an important issue in clinical medicine for many years. In the 70 s of the last century, the association between gastroesophageal reflux disease and BE was detected. Only ten years later, the association between BE and adenocarcinoma of the esophagus was reported. Starting in the 90s in Europe, endoscopic resection and ablation have seen an expanding role in the management of BE. In analogy with other diseases, patients are undergoing individualized surveillance and treatment strategies. In non-neoplastic Barrett’s esophagus, surveillance intervals are clearly defined by national and European guidelines. Only in case of malignant transformation of BE which may range from low-grade dysplasia to high-grade dysplasia and early Barrett’s cancer, endoscopic therapy is indicated. At present, there are emerging techniques of artificial intelligence. Due to these rapid developments in BE management, it is important to keep an eye on the current status of BE management.

Schlüsselwörter

Barrett-Ösophagus - Überwachung - endoskopische Resektion - endoskopische Ablation

Key words

Barrett’s esophagus - surveillance - endoscopic resection - endoscopic ablation

Publication History

Article published online:
23 January 2023

• Literatur

• 1 Eusebi LH, Cirota GG, Zagari RM. et al. Global prevalence of Barrett’s esophagus and oesophageal cancer in individuals with gastro-oesophageal reflux: a systematic review and meta-analysis. Gut 2021; 70: 456-463
• 2 Allen JE, Desai M, Roumans CAM. et al. Low risk of progression of Barrett’s esophagus to neoplasia in women. J Clin Gastroenterol 2021; 55: 321-326
• 3 Koop H, Fuchs KH, Labenz J. et al. S2k-Leitlinie: Gastroösophageale Refluxkrankkheit unter Federführung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 2014; 52: 1299-1346
• 4 Weusten B, Bisschops R, Coron E. et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191-198
• 5 Behrens A, Pech O, Wuthnow E. et al. Detection of early neoplasia in Barrett’s esophagus: focus attention on index endoscopy in short-segment-Barrett’s esophagus with random biopsies. Z Gastroenterol 2015; 53: 568-572
• 6 Leitlinienprogramm Onkologie. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus (Version 3). AWMF-Registernummer 021/0230L. Im Internet:. https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Oesophaguskarzinom/Version_3/LL_%C3%96sophaguskarzinom_Langversion_3.1.pdf ; Stand: 17.10.2022
• 7 Qumseya BJ, Wang H, Badie N. et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett’s esophagus: a meta-analysis and systematic review. Clin Gastroenterol Hepatol 2013; 11: 1562-1570.e1–2
• 8 Kandiah K, Chedgy FJG, Subramaniam S. et al. International development and validation of a classification system for the identification of Barrett’s neoplasia using acetic acid chromoendoscopy: the Portsmouth acetic acid classification (PREDICT). Gut 2018; 67: 2085-2091
• 9 Sharma P, Bergman JGHM, Goda K. et al. Development and validation of a classification system to identify high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus using narrow-band imaging. Gastroenterology 2016; 150: 591-598
• 10 Struyvenberg MR, de Groof AJ, van der Putten J. et al. A computer-assisted algorithm for narrow-band imaging-based tissue characterization in Barrett’s esophagus. Gastrointest Endosc 2021; 93: 89-98
• 11 Hashimoto R, Requa J, Dao T. et al. Artificial intelligence using convolutional neuronal networks for real-time detection of early esophageal neoplasia in Barrett’s esophagus. Gastrointest Endosc 2020; 91: 1264-1271
• 12 Omidvari AH, Hazelton WD, Lauren BN. et al. The optimal age to stop endoscopic surveillance of patients with Barrett’s esophagus based on sex and comorbidity: a comparative cost-effectiveness analysis. Gastroenterology 2021; 161: 487-494
• 13 Pech O, May A, Manner H. et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 2014; 146: 652-660
• 14 Manner H, Rabenstein T, Pech O. et al. Ablation of residual Barrett’s epithelium after endoscopic resection: a randomized long-term follow-up study of argon plasma coagulation vs. surveillance (APE study). Endoscopy 2014; 46: 6-12
• 15 Pouw R, Klaver E, Phoa KN. et al Radiofrequency ablation for low-grade dysplasia in Barrett’s esophagus: long-term outcome of a randomized trial. Gastrointest Endosc 2020; 92: 569-574
• 16 Manner H, Pech O, Heldmann Y. et al. Efficacy, safety, and long-term results of endoscopic treatment for the early stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol 2013; 11: 630-635
• 17 Pimentel-Nunes P, Libanio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy 2022; 54: 591-622
• 18 Manner H, May A, Kouti I. et al. Efficacy and safety of Hybrid-APC for the ablation of Barrett’s esophagus. Surg Endosc 2016; 30: 1364-1370
• 19 Knabe M, Beyna T, Rösch T. et al. Hybrid-APC in combination with resection for the endoscopic treatment of neoplastic Barrett’s esophagus: a prospective multicenter study. Am J Gastroenterol 2022; 117: 110-119