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Endoskopie heute 2006; 19(4): 222-227
DOI: 10.1055/s-2006-942311
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Barrett-Ösophagus: Endoskopische Diagnose und Therapie

Barrett's Esophagus: Endoscopical Diagnosis and TherapyA. Meining1 , T. Rösch2
  • 1II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München
  • 2Zentrale Interdisziplinäre Endoskopie, Charite Universitätsmedizin Berlin, Campus Virchow
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Publication History

Publication Date:
26 January 2007 (online)

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Zusammenfassung

In den letzten Jahren gab es enorme Anstrengungen in der Verbesserung der Diagnose und Therapie des Barrett-Ösophagus. Durch moderne bildgebende Verfahren bis zur Darstellung zellulärer Strukturen in-vivo ist es möglich, schon während der Endoskopie eine Gewebstypisierung durchzuführen. Aufgrund des häufig fokalen Auftretens der Barrett-Metaplasie, aber auch der Barrett-Neoplasie besteht jedoch auch unter Ausschöpfung aller moderner Verfahren nach wie vor das Risiko eines Sampling-Errors. Für die tägliche Praxis kann daher bis auf Weiteres nicht auf den histopathologischen Goldstandard mittels 4-Quadrantenbiopsie verzichtet werden. Im Bereich der Barrett-Therapie ist inzwischen der Einsatz minimalinvasiver endoskopisch-ablativer Verfahren Leitlinien-gerecht fest etabliert. Häufig ist jedoch individuell eine Kombination mehrerer - z. T. unterschiedlicher - Verfahren bei multifokalen Auftreten neoplastischer Veränderungen notwendig. Zukünftige Studien werden zeigen, was das optimale endoskopische bzw. interventionelle Verfahren zur totalen Barrett-Ablation ohne Nachwirkungen (Strikturen, Rezidive) sein wird.

Abstract

The endoscopical diagnosis and treatment of Barrett's esophagus has dramatically improved the last years. Today, modern imaging methodology enables an almost histological image of the mucosa in-vivo during the endoscopic procedure. Nevertheless, despite all these modern methods there is still a sampling bias for detection of Barrett's metaplasia and Barrett's neoplasia. Hence, standard histopathology after four-quadrant-random biopsy still has to be regarded as the gold standard for daily routine practise. For therapy of Barrett's esophagus, minimal invasive therapy by the use of endoscopical ablation of the mucosa has been established in published guidelines. However, an individual approach by combining different methods is often requested for treatment of multifocal neoplasia. It will be the aim of future studies to find the ideal endoscopical therapy for complete ablation of Barrett's esophagus without potential side effects (strictures, recurrence of neoplasia).

Schlüsselwörter

Barrett-Ösophagus - Diagnose - Therapie - Endoskopie

Key words

Barrett's esophagus - diagnosis - therapy - endoscopy

Literatur

  • 1 Behrens A, May A, Gossner L, Gunter E, Pech O, Vieth M, Stolte M, Seitz G, Ell C. Curative treatment for high-grade intraepithelial neoplasia in Barrett's esophagus.  . 2005;  37 999-1005
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Breyer H P, Silva De Barros S G, Maguilnik I, Edelweiss M I. Does methylene blue detect intestinal metaplasia in Barrett' esophagus?.  Gastrointest Endosc. 2003;  57 505-509
    CrossrefPubMedGoogle Scholar
  • 3 Conio M, Repici A, Cestari R, Blanchi S, Lapertosa G, Missale G, Della Casa D, Villanacci V, Calandri P G, Filiberti R. Endoscopic mucosal resection for high-grade dysplasia and intramucosal carcinoma in Barrett's esophagus: an Italian experience.  . 2005;  11 6650-6655
    PubMedGoogle Scholar
  • 4 Corley D A, Levin T R, Habel L A, Weiss N S, Buffler P A. Surveillance and survival in Barrett's adenocarcinomas: a population-based study.  Gastroenterol. 2002;  122 633-640
    CrossrefPubMedGoogle Scholar
  • 5 Eckardt V F, Kanzler G, Bernhard G. Life expectancy and cancer risk in patients with Barrett's esophagus: a prospective controlled investigation.  Am J Med. 2001;  111 33-37
    CrossrefPubMedGoogle Scholar
  • 6 Ell C, May A, Gossner L, Pech O, Gunter E, Mayer G, Henrich R, Vieth M, Muller H, Seitz G, Stolte M. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus.  . 2000;  118 670-677
    CrossrefPubMedGoogle Scholar
  • 7 Giovannini M, Bories E, Pesenti C, Moutardier V, Monges G, Danisi C, Lelong B, Delpero J R. Circumferential endoscopic mucosal resection in Barrett's esophagus with high-grade intraepithelial neoplasia or mucosal cancer. Preliminary results in 21 patients.  . 2004;  36 782-787
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Guelrud M, Herrera I, Essenfeld H, Castro J. Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett's esophagus.  Gastrointest Endosc. 2001;  53 559-565
    CrossrefPubMedGoogle Scholar
  • 9 Hage M, Siersema P D, van Dekken H, Steyerberg E W, Haringsma J, van de Vrie W, Grool T E, van Veen R L, Sterenborg H J, Kuipers E J. 5-aminolevulinic acid photodynamic therapy versus argon plasma coagulation for ablation of Barrett's oesophagus: a randomised trial.  . 2004;  53 785-790
    CrossrefPubMedGoogle Scholar
  • 10 Hirota W K, Loughney T M, Lazas D J, Maydonovitch C L, Rholl V, Wong R K. Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data.  Gastroenterology. 1999;  116 277-285
    CrossrefPubMedGoogle Scholar
  • 11 Kahaleh M, Van Laethem J L, Nagy N, Cremer M, Deviere J. Long-term follow-up and factors predictive of recurrence in Barrett's esophagus treated by argon plasma coagulation and acid suppression.  Endoscopy. 2002;  34 950-955
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Kara M A, Peters F P, Rosmolen W D, Krishnadath K K, ten Kate F J, Fockens P, Bergman J J. High-resolution endoscopy plus chromoendoscopy or narrow-band imaging in Barrett's esophagus: a prospective randomized crossover study.  Endoscopy. 2005;  61 679-685
    CrossrefPubMedGoogle Scholar
  • 13 Kara M A, Peters F P, Ten Kate F J, Van Deventer S J, Fockens P, Bergman J J. Endoscopic video autofluorescence imaging may improve the detection of early neoplasia in patients with Barrett's esophagus.  Gastrointest Endosc. 2005;  61 679-685
    CrossrefPubMedGoogle Scholar
  • 14 Lovat L B, Jamieson N F, Novelli M R, Mosse C A, Selvasekar C, Mackenzie G D, Thorpe S M, Bown S G. Photodynamic therapy with m-tetrahydroxyphenyl chlorin for high-grade dysplasia and early cancer in Barrett's columnar lined esophagus.  Gastrointest Endosc. 2005;  62 617-623
    CrossrefPubMedGoogle Scholar
  • 15 Madisch A, Miehlke S, Bayerdorffer E, Wiedemann B, Antos D, Sievert A, Vieth M, Stolte M, Schulz H. Long-term follow-up after complete ablation of Barrett's esophagus with argon plasma coagulation.  World J Gatroenterol. 2005;  11 1182-1186
    PubMedGoogle Scholar
  • 16 Manner H, May A, Miehlke S, Kraemer W, Niemann G, Wigginghaus B, Dertinger S, Schimming W, Kiesslich R, Stolte M, Ell C. A Prospective Multicenter Trial on Ablation of Non-Neoplastic Barrett's Epithelium by Endoscopic Argon Plasma Coagulation in Combination with Esomeprazole (APBANEX).  Gastrointest Endosc. 2005;  61 AB 136
    PubMedGoogle Scholar
  • 17 May A, Gossner L, Pech O, Muller H, Vieth M, Stolte M, Ell C. Intraepithelial high-grade neoplasia and early adenocarcinoma in short-segment Barrett's esophagus (SSBE): curative treatment using local endoscopic treatment techniques.  Endoscopy. 2002;  34 604-610
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Meining A, Ott R, Becker I, Hahn S, Mühlen J, Werner M, Höfler H, Classen M, Heldwein W, T R ösch. The Munich Barrett follow up study: suspicion of Barrett's oesophagus based on either endoscopy or histology only - what is the clinical significance?.  Gut. 2004;  53 1402-1407
    CrossrefPubMedGoogle Scholar
  • 19 Meining A, Rösch T, Kiesslich R, Muders M, Sax F, Heldwein W. Inter- and intra-observer-variability of magnification chromoendoscopy for detection of specialized intestinal metaplasia at the gastroesophageal junction.  Endoscopy. 2004;  36 55-59
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Messmann H, Ell C, Fein M, Kiesslich R, Ortner M, Porschen R, Stolte M. [Topic Complex VI: Barrett esophagus].  Z Gastroenterol. 2005;  43 184-190
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Mino-Kenudson M, Brugge W R, Puricelli W P, Nakatsuka L N, Nishioka N S, Zukerberg L R, Misdraji J, Lauwers G Y. Management of superficial Barrett's epithelium-related neoplasms by endoscopic mucosal resection: clinicopathologic analysis of 27 cases.  Am J Surg Pathol. 2005;  29 680-686
    CrossrefPubMedGoogle Scholar
  • 22 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
    CrossrefPubMedGoogle Scholar
  • 23 Olliver J R, Wild C P, Sahay P, Dexter S, Hardie L J. Chromoendoscopy with methylene blue and associated DNA damage in Barrett's oesophagus.  Lancet. 2003;  362 373-374
    CrossrefPubMedGoogle Scholar
  • 24 Overholt B F, Lightdale C J, Wang K K, Canto M I, Burdick S, Haggitt R C, Bronner M P, Taylor S L, Grace M G, Depot M. International Photodynamic Group for High-Grade Dysplasia in Barrett's Esophagus . 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
    CrossrefPubMedGoogle Scholar
  • 25 Peters F, Kara M, Rosmolen W, Aalders M, Ten Kate F, Krishnadath K, van Lanschot J, Fockens P, Bergman J. Poor results of 5-aminolevulinic acid-photodynamic therapy for residual high-grade dysplasia and early cancer in barrett esophagus after endoscopic resection.  Endoscopy. 2005;  37 418-424
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Pohl H, Adler A, Abou-Rebyeh H, Veltzke-Schlieker W, Rösch T. Endoskopische Kongress-Highlights 2005: Übersichten über endoskopische Abstracts von DDW, DGVS und UEGW.  Z Gastroenterol. 2006;  44 513-523
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Polglase A L, McLaren W J, Skinner S A, Kiesslich R, Neurath M F, Delaney P M. A fluorescence confocal endomicroscope for in vivo microscopy of the upper- and the lower-GI tract.  Gastrointest Endosc. 2005;  62 686-695
    CrossrefPubMedGoogle Scholar
  • 28 Ragunath K, Krasner N, Raman V S, Haqqani M T, Phillips C J, Cheung I. Endoscopic ablation of dysplastic Barrett's oesophagus comparing argon plasma coagulation and photodynamic therapy: a randomized prospective trial assessing efficacy and cost-effectiveness.  Gastrointest Endosc. 2005;  62 488-498
    CrossrefPubMedGoogle Scholar
  • 29 Sampliner R E. and the Practice Parameters Committee of the American College of Gastroenterology . Updated practice guidelines on the diagnosis, surveillance, and therapy of Barrett's esophagus.  Am J Gastroenterol. 2002;  97 1888-1895
    CrossrefPubMedGoogle Scholar
  • 30 Sandick van J W, van Lanschot J JB, Kuiken B W, Tytgat G NJ, Offerhaus G JA, Obertop H. Impact of endoscopic biopsy surveillance of Barrett's oesophagus on pathological stage and clinical outcome of Barrett's carcinoma.  Gut. 1998;  43 216-222
    CrossrefPubMedGoogle Scholar
  • 31 Schnell T G, Sontag S J, Chejfec G, Aranha G, Metz A, O'Connell S, Seidel U J, Sonnenberg A. Long-term nonsurgical management of Barrett's esophagus with high-grade dysplasia.  Gastroenterology. 2001;  120 1607-1619
    CrossrefPubMedGoogle Scholar
  • 32 Schulz H, Miehlke S, Antos D, Schentke K U, Vieth M, Stolte M, Bayerdorffer E. Ablation of Barrett's epithelium by endoscopic argon plasma coagulation in combination with high-dose omeprazole.  Gastrointest Endosc. 2000;  51 659-663
    CrossrefPubMedGoogle Scholar
  • 33 Seewald S, Akaraviputh T, Seitz U, Brand B, Groth S, Mendoza G, He X, Thonke F, Stolte M, Schroeder S, Soehendra N. Circumferential EMR and complete removal of Barrett's epithelium: a new approach to management of Barrett's esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma.  Gastrointest Endosc. 2003;  57 854-859
    CrossrefPubMedGoogle Scholar
  • 34 Shaheen N J, Crosby M A, Bozymski E M, Sandler R S. Is there publication bias in the reporting of cancer risk in Barrett's esophagus?.  Gastroenterology. 2000;  119 333-338
    CrossrefPubMedGoogle Scholar
  • 35 Sharma P, Weston A P, Morales T, Topalovski M, Mayo M S, Sampliner R E. Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia.  Gut. 2000;  46 9-13
    CrossrefPubMedGoogle Scholar
  • 36 Spechler S J, Goyal R K. Barrett's esophagus.  N Engl J Med. 1986;  315 362-371
    PubMedGoogle Scholar
  • 37 Stein H J, Feith M, Mueller J, Werner M, Siewert J R. Limited resection for early adenocarcinoma in Barrett's esophagus.  Ann Surg. 2000;  232 733-742
    CrossrefPubMedGoogle Scholar
  • 38 Vieth M, Ell C, Gossner L, May A, Stolte M. Histological analysis of endoscopic resection specimens from 326 patients with Barrett's esophagus and early neoplasia.  Endoscopy. 2004;  36 776-781
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Weinstein W M, Ippoliti A F. The diagnosis of Barrett's esophagus: Goblets, goblets, goblets.  Gastrointest Endosc. 1996;  44 91-94
    CrossrefPubMedGoogle Scholar

PD Dr. med. A. Meining

II. Medizinische Klinik · Klinikum rechts der Isar der TU München

Ismaningerstr. 22

81675 München

Phone: 0 89/4 14 00

Fax: 0 89/41 40 49 05

Email: Alexander.Meining@lrz.tum.de

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