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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Prof. Dr. Helmut Messmann
III. Medizinische Klinik
Klinikum Augsburg
86009 Augsburg
Stenglinstraße 2
Email: helmut.messmann@klinikum-augsburg.de
