Barrett-Karzinom - Diagnose, Screening, Surveillance, endoskopische Therapie, Prävention

Zusammenfassung

Das Adenokarzinom des unteren Ösophagus kann auch als Barrett-Karzinom bezeichnet werden, da es sich aus einem Barrett-Ösophagus entwickelt. Der Barrett-Ösophagus als Präneoplasie wird aktuell definiert als endoskopisch sichtbare Zylinderepithelmetaplasie im unteren Ösophagus, in der sich histologisch eine intestinale Metaplasie nachweisen lässt. Eine andere histologische Form der Zylinderepithelmetaplasie im unteren Ösophagus ist kardiatypische Mukosa, die vermutlich der intestinalen Metaplasie vorausgeht, aber keine Becherzellen wie diese enthält. Die Konversionsrate vom Barrett-Ösophagus zum Barrett-Karzinom beträgt 0,5 bis1 % pro Jahr. Patienten mit Refluxbeschwerden sollten frühzeitig endoskopiert werden, um einen Barrett-Ösophagus zu suchen (Screening). Die Identifizierung eines Barrett-Ösophagus hat dann regelmäßige endoskopische Kontrollen zur Folge, deren Intervalle durch Leitlinien festgelegt sind (Surveillance). Ziel ist die Früherkennung einer Neoplasie. Auf das Epithel oder die Mukosa beschränkte Neoplasien können meist endoskopisch reseziert werden. Die histologisch am Resektat bestimmte Infiltrationstiefe erlaubt eine Abschätzung des Lymphknotenmetastasierungsrisikos und ist somit essenziell zur abschließenden Beurteilung, ob der endoskopische Eingriff als kurativ angesehen werden kann. Das Metastasierungsrisiko ist individuell gegenüber dem Morbiditäts- und Mortalitätsrisiko bei einer chirurgischen Resektion abzuwägen. Die rasche Zunahme der Inzidenz des Barrett-Karzinoms in westlichen Ländern deutet auf Lebensstil-Faktoren, insbesondere Übergewicht, als Ursache hin. Daten aus Interventionsstudien zur Prävention stehen jedoch noch aus.

Abstract

An adenocarcinoma of the distal esophagus may also be designated as Barrett’s carcinoma as it evolves from Barrett’s esophagus. Barrett’s esophagus currently is defined as a columnar metaplasia of the distal esophagus, as identified by endoscopy, that, upon histopathology, is confirmed to contain intestinal metaplasia. A different histological entity of columnar metaplasia of the distal esophagus is cardia-type mucosa which probably preceeds intestinal metaplasia, but lacks goblet cells typical for the latter. The conversion rate from Barrett’s esophagus to Barrett’s carcinoma amounts to 0.5 to 1 % per year. Patients with reflux symptoms should undergo early endoscopy in order to search for Barrett’s esophagus (screening). In those cases where Barrett’s esophagus is identified, regular endoscopic controls should be scheduled (surveillance). The intervals for this have been defined by recent consented guidelines. The aim is to detect neoplasia early. Neoplasia confined to the epithelium or mucosal layer can mostly be treated by endoscopic resection. The depth of infiltration, as determined by histolopathology of the resected specimen, allows one to estimate the risk of lymph node metastasis, and therefore is crucial for the final judgment as to whether the endoscopic intervention may be considered curative. Individually, the risk of metastasis has to be weighed against the risk of morbidity and mortality conferred by the alternative surgical resection. The rapid increase of the incidence of Barrett’s carcinoma in Western countries suggests that life style factors, in particular overweight, having a causal role. Data from interventional trials on prevention are, however, pending.

Schlüsselwörter

Adenokarzinom - Barrett-Ösophagus - Screening - Surveillance - endoskopische Resektion

Key words

adenocarcinoma - Barrett’s esophagus - screening - surveillance - endoscopic resection

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