Barrett-Ösophagus – Diagnostik und Therapie – Update

Kernaussagen

Definition und Diagnose

• Die Verdachtsdiagnose eines Barrett-Ösophagus wird endoskopisch gestellt, muss aber bisher 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 mittels EMR bzw. ESD von IEN und Frühkarzinomen ist im Vergleich zur Operation offensichtlich gleich effektiv, aber nebenwirkungsärmer und mit geringerer Mortalität und Morbidität vergesellschaftet, sodass sie sich wohl zur Methode der Wahl entwickeln wird.

• Ablative Verfahren bleiben Methode der 2. Wahl oder werden mit den Resektionsverfahren kombiniert.

• 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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