Überwachung von Patienten mit Barrett-Ösophagus - eine Übersicht

Zusammenfassung

Der Barrett-Ösophagus stellt eine schwer wiegende Komplikation des gastroösophagealen Refluxes dar und ist mit einem 30- bis 125fach erhöhten Karzinomrisiko assoziiert. Dabei hat die Zunahme der Inzidenz des Adenokarzinoms den Barrett-Ösophagus in den Blickpunkt des Interesses gestellt. Nach anfänglichen Unstimmigkeiten in der Definition des Barrett-Ösophagus werden heute Barrett-Segmente, d. h. histologischer Nachweis von spezialisiertem intestinalisierten Zylinderepithel, von mehr als 3 cm Länge allgemein als Long-Segment-Barrett-Ösophagus (LBS) und solche mit weniger als 3 cm Ausdehnung als Short-Segment-Barrett-Ösophagus (SBS) bezeichnet. Histologischer Nachweis von intestinalem Epithel ohne entsprechende endoskopische Veränderungen wird als mikroskopischer Barrett- oder Ultra-Short-Barrett-Ösophagus definiert.

Der Nachweis dysplastischer Veränderungen gilt als der wichtigste Risikofaktor für die Entstehung eines Adenokarzinoms. Die Überwachungsempfehlungen orientieren sich am Vorhandensein bzw. Fehlen von Dysplasien unterschiedlichen Schweregrades. Zahlreiche neue Methoden (Färbeverfahren, Fluoreszenzdiagnostik, optische Kohärenztomographie) werden in der Diagnostik des Barrett-Ösophagus und der Früherkennung maligner und prämaligner Läsionen evaluiert. Dennoch sind zum jetzigen Zeitpunkt 4 Quadrantenbiopsien in Abständen von 1-2 cm für den LBS empfehlenswert, die Zeitintervalle werden dabei vom Nachweis dysplastischer Areale bestimmt. Ob Patienten mit SBS ähnlich wie Patienten mit LBS zu überwachen sind, ist noch unklar und bedarf weiterer Studien.

Surveillance of patients with Barrett’s esophagus

Barrett’s esophagus is a major complication of gastroesophageal reflux disease and is associated with 30-125 fold increased risk of developing carcinoma. Because of the rising incidence of esophageal adenocarcinoma the malignant potential of Barrett’s esophagus has been generally recognized. The definition of Barrett’s esophagus has evolved over the last decades. It is now accepted that “Long-Barrett-Segment” (LBS) is used when intestinal-type epithelium, characterized by the presence of goblet cells, is detected in the distal esophagus > 3 cm in length. The term “Short-Barrett-Segment” (SBS) is defined by intestinal metaplasia detection < 3 cm in length in the distal esophagus. Recently, there has been focus on microscopic Barrett’s esophagus, so called “Ultra-Short-Barrett’s esophagus”, with histological evidence of intestinal metaplasia without endoscopic appearance.

The most significant predictor of the risk of malignancy in patients with Barrett’s esophagus is the presence of dysplasia. Guidelines for surveillance are based on the diagnosis of dysplastic lesions. New methods (e. g. Methylene blue staining, endoscopic fluorescence detection, OCT) to improve the recognition of Barrett’s esophagus and especially enhance the detection of premaligant and malignant lesions are under evaluation. So far, the standard biopsy protocol for patients with LBS includes biopsies in the 4 quadrants every 1-2 cm, whereas the appropriate surveillance intervals are dependent on the grade of dysplasia. Whether surveillance in patients with SBS has to be similar to that in patients with LBS is unclear and needs further evaluation.

Barrett-Ösophagus - Überwachung - 5-Aminolävulinsäure - endoskopische Fluoreszenzdiagnostik - Dysplasie - Adenokarzinom - Färbeverfahren

Barrett’s Esophagus - Surveillance - 5-aminolevulinic Acid - Endoscopic Fluorescence Detection - Dysplasia - Adenocarcinoma - Methylene Blue Staining

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