Wann ist eine endoskopische Resektion einer Neoplasie im Ösophagus und der Kardia indiziert?

Zusammenfassung

Die Sicherheit und Effektivität der endoskopischen Therapie von frühen Neoplasien im Barrett-Ösophagus und im Plattenepithel des Ösophagus in definierten Grenzen ist gut belegt und macht sie zur Therapie der ersten Wahl. Sie gewährleistet bei einer niedrigen Morbiditätsrate dem Patienten eine gute Lebensqualität und einen Organerhalt. Das Mortalitätrisiko ist minimal. Entscheidend für den Erfolg ist die frühe Diagnosestellung. Die Ösophagusresektion bzw. Radio-/Chemotherapie sind heute in der Therapie von ösophagealen Frühkarzinomen Reserveverfahren, die nur bei Patienten zum Einsatz kommen sollten, bei denen der Tumor definierte histologische Risikofaktoren aufweist oder die endoskopische Therapie versagt. Aktuell wird eine Ausweitung der Indikationskriterien für die endoskopische Therapie von Barrett-Adenofrühkarzinomen diskutiert, die eine oberflächliche Submukosainfiltration zeigen und keine weiteren histologischen Risikofaktoren aufweisen.

Abstract

There is good evidence for the safety and efficacy of endoscopic treatment for early neoplasia in Barrettʼs oesophagus and in oesophageal squamous epithelium within defined margins, and this form of therapy is therefore the treatment of choice. With a low morbidity rate, it offers patients a good quality of life with preservation of the organ. The mortality risk is minimal. The decisive element for success is early diagnosis. Oesophageal resection and radiotherapy/chemotherapy are nowadays reserve procedures in the treatment of early oesophageal carcinoma and should only be used in patients in whom the tumour shows defined histological risk factors or endoscopic therapy has failed. Discussion is currently taking place on whether the criteria used to indicate endoscopic therapy for early Barrettʼs adenocarcinoma can be expanded to include lesions with superficial submucosal infiltration and no additional histological risk factors.

Schlüsselwörter

Endoskopie - endoskopische Intervention - Krebs

Key words

endoscopy - endoscopic intervention - cancer

• Literatur

• 1 Neuhaus H, Terheggen G, Rutz EM et al. Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrettʼs esophagus. Endoscopy 2012; 44: 1105-1113
• 2 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 2013; Nov 20
• 3 Stefanidis D, Hope WW, Kohn GP. Guidelines for surgical treatment of gastroesophageal reflux disease. SAGES Guidelines Committee. Surg Endosc 2010; 24: 2647-2669
• 4 Moss A, Bourke MJ, Hourigan LF et al. Endsocopic resection for Barrettʼs high-grade dysplasia and early esophageal adenocarcinoma: an essential staging procedure with long-term therapeutic benefit. Am J Gastroenterol 2010; 105: 1276-1283
• 5 Prasad GA, Wu TT, Wigle DA. Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrettʼs esophagus. Gastroenterology 2009; 137: 815-823
• 6 Pech O, Bollschweiler E, Manner H et al. Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrettʼs esophagus at two high-volume centers. Ann Surg 2011; 254: 67-72
• 7 Stein HJ, Feith M, Bruecher BL et al. Early esophageal squamous cell and adenocarcinoma: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection. Ann Surg 2005; 242: 566-573 discussion 573–575
• 8 Buskens CJ, Westerterp M, Lagarde SM et al. Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features. Gastrointest Endosc 2004; 60: 703-710
• 9 Bollschweiler E, Baldus SE, Schröder W et al. High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy 2006; 38: 149-156
• 10 Rice TW, Blackstone EH, Goldblum JR et al. Superficial adenocarcinoma of the esophagus. J Thorac Cardiovasc Surg 2001; 122: 1077-1090
• 11 Oh DS, Hagen JA, Chandrasoma PT et al. Clinical biology and surgical therapy of intramucosal adenocarcinoma of the esophagus. J Am Coll Surg 2006; 203: 152-161
• 12 Lorenz D, Origer J, Pauthner M et al. Prognostic Risk Factors of Esophageal Adenocarcinomas. Ann Surg 2013; Nov 12 [Epub ahead of print]
• 13 Ell C, May A, Gossner L et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrettʼs esophagus. Gastroenterology 2000; 118: 670-677
• 14 Pech O, Behrens A, May A et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrettʼs oesophagus. Gut 2008; 57: 1200-1206
• 15 Pouw RE, Seewald S, Gondrie JJ et al. Stepwise radical endoscopic resection for eradication of Barrettʼs oesophagus with early neoplasia in a cohort of 169 patients. Gut 2010; 59: 1169-1177
• 16 Behrens A, Pech O, Lorenz D et al. Barrett Karzinom: Bessere Prognose durch verbesserte Diagnostik und Therapie. Dtsch Arztebl 2011; 108: 313-319
• 17 Alvarez Herrero L, Pouw RE, van Vilsteren FG et al. Risk of lymph node metastasis associated with deeper invasion by early adenocarcinoma of the esophagus and cardia: study based on endoscopic resection specimens. Endoscopy 2010; 42: 1030-1036
• 18 Manner H, Pech O, Heldmann Y et al. Efficacy, safety, and long-term results of endoscopic treatment for early stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol 2013; 11: 630-635
• 19 Badreddine RJ, Prasad GA, Lewis JT et al. Depth of submucosal invasion does not predict lymph node metastasis and survival of patients with esophageal carcinoma. Clin Gastroenterol Hepatol 2010; 8: 248-253
• 20 Manner H, Rabenstein T, Braun K et al. What should we do with the remainder of Barrettʼs segment after endoscopic resection of early Barrettʼs cancer? Intermediate results of the first prospective randomized trial on the APC ablation of residual Barrettʼs mucosa with concomitant esomeprazole therapy versus surveillance without ablation after ER of Barrettʼs cancer. Gastrointest Endosc 2010; 71: AB175
• 21 Pouw RE, Gondrie JJ, Rygiel AM et al. Properties of the neosquamous epithelium after radiofrequency ablation of Barrettʼs esophagus containing neoplasia. Am J Gastroenterol 2009; 104: 1366-1373
• 22 Pech O, May A, Gossner L et al. Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 2007; 39: 30-35
• 23 Ciocirlan M, Lapalus MG, Hervieu V et al. Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 2007; 39: 24-29
• 24 Katada C, Muto M, Momma K et al. Clinical outcome after endoscopic mucosal resection for esophageal squamous cell carcinoma invading the muscularis mucosae–a multicenter retrospective cohort study. Endoscopy 2007; 39: 779-783
• 25 Tajima Y, Nakanishi Y, Ochiai A et al. Significance of involvement by squamous cell carcinoma of the ducts of esophageal submucosal glands. Analysis of 201 surgically resected superficial squamous cell carcinomas. Cancer 2000; 89: 248-254