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Erschienen in: Der Gastroenterologe 6/2013

01.11.2013 | CME Zertifizierte Fortbildung

Update Barrett-Ösophagus

verfasst von: PD Dr. M. Anders

Erschienen in: Die Gastroenterologie | Ausgabe 6/2013

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Zusammenfassung

Barrett-Ösophagus bezeichnet die intestinale Metaplasie der unteren Speiseröhre, die infolge einer gastroösophagealen Refluxkrankheit auftreten kann. Ziel der endoskopischen Überwachung ist die rechtzeitige Diagnose und Therapie des neoplastischen Barrett-Ösophagus, der bei einem Teil der Patienten entsteht. Sowohl zur endoskopischen Diagnostik als auch zur Therapie sind hierzu in den vergangenen Jahren neue Optionen, z. B. die virtuelle Chromoendoskopie und die Radiofrequenzablation, vorgestellt worden. Im vorliegenden Artikel sollen derzeit vorliegende Erkenntnisse zum klinischen Nutzen dieser Methoden erörtert werden. Ebenso werden aktuelle Daten zur Entstehung des Barrett-Ösophagus und zur malignen Transformation vorgestellt.
Literatur
1.
Zurück zum Zitat Ronkainen J, Talley NJ, Storskrubb T et al (2011) Erosive esophagitis is a risk factor for Barrett’s esophagus: a community-based endoscopic follow-up study. Am J Gastroenterol 106: 1946–1952PubMedCrossRef Ronkainen J, Talley NJ, Storskrubb T et al (2011) Erosive esophagitis is a risk factor for Barrett’s esophagus: a community-based endoscopic follow-up study. Am J Gastroenterol 106: 1946–1952PubMedCrossRef
2.
Zurück zum Zitat Quante M, Bhagat G, Abrams JA et al (2012) Bile acid and inflammation activate gastric cardia stem cells in a mouse model of barrett-like metaplasia. Cancer Cell 21: 36–51PubMedCrossRef Quante M, Bhagat G, Abrams JA et al (2012) Bile acid and inflammation activate gastric cardia stem cells in a mouse model of barrett-like metaplasia. Cancer Cell 21: 36–51PubMedCrossRef
3.
Zurück zum Zitat Singh S, Sharma AN, Murad MH et al (2013) Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, doi: 10.1016/j.cgh.2013.05.009 Singh S, Sharma AN, Murad MH et al (2013) Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, doi: 10.1016/j.cgh.2013.05.009
4.
Zurück zum Zitat Chak A, Ochs-Balcom H, Falk G et al (2006) Familiality in Barrett’s esophagus, adenocarcinoma of the esophagus, and adenocarcinoma of the gastroesophageal junction. Cancer Epidemiol Biomarkers Prev 15: 1668–1673PubMedCrossRef Chak A, Ochs-Balcom H, Falk G et al (2006) Familiality in Barrett’s esophagus, adenocarcinoma of the esophagus, and adenocarcinoma of the gastroesophageal junction. Cancer Epidemiol Biomarkers Prev 15: 1668–1673PubMedCrossRef
5.
Zurück zum Zitat Su Z, Gay LJ, Strange A et al (2012) Common variants at the MHC locus and at chromosome 16q24.1 predispose to Barrett’s esophagus. Nat Genet 44: 1131–1136PubMedCrossRef Su Z, Gay LJ, Strange A et al (2012) Common variants at the MHC locus and at chromosome 16q24.1 predispose to Barrett’s esophagus. Nat Genet 44: 1131–1136PubMedCrossRef
6.
Zurück zum Zitat Bollschweiler E, Wolfgarten E, Gutschow C et al (2001) Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 92: 549–555PubMedCrossRef Bollschweiler E, Wolfgarten E, Gutschow C et al (2001) Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 92: 549–555PubMedCrossRef
7.
Zurück zum Zitat Hvid-Jensen F, Pedersen L, Drewes AM et al (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 365: 1375–1383PubMedCrossRef Hvid-Jensen F, Pedersen L, Drewes AM et al (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 365: 1375–1383PubMedCrossRef
8.
Zurück zum Zitat Downs-Kelly E, Mendelin JE, Bennett AE et al (2008) Poor interobserver agreement in the distinction of high-grade dysplasia and adenocarcinoma in pretreatment Barrett’s esophagus biopsies. Am J Gastroenterol 103: 2333–2340 (quiz2341)PubMedCrossRef Downs-Kelly E, Mendelin JE, Bennett AE et al (2008) Poor interobserver agreement in the distinction of high-grade dysplasia and adenocarcinoma in pretreatment Barrett’s esophagus biopsies. Am J Gastroenterol 103: 2333–2340 (quiz2341)PubMedCrossRef
9.
Zurück zum Zitat Koop H, Schepp W, Müller-Lissner S et al (2005) Consensus Conference of the DGVS on gastroesophageal reflux. Z Gastroenterol 43: 163–164PubMedCrossRef Koop H, Schepp W, Müller-Lissner S et al (2005) Consensus Conference of the DGVS on gastroesophageal reflux. Z Gastroenterol 43: 163–164PubMedCrossRef
10.
Zurück zum Zitat Wani S (2012) Management of low-grade dysplasia in Barrett’s esophagus. Curr Opin Gastroenterol 28: 370–376PubMedCrossRef Wani S (2012) Management of low-grade dysplasia in Barrett’s esophagus. Curr Opin Gastroenterol 28: 370–376PubMedCrossRef
11.
Zurück zum Zitat Duggan C, Onstad L, Hardikar S et al (2013) Association Between Markers of Obesity and Progression From Barrett’s Esophagus to Esophageal Adenocarcinoma. Clin Gastroenterol Hepatol, doi: 10.1016/j.cgh.2013.02.017 Duggan C, Onstad L, Hardikar S et al (2013) Association Between Markers of Obesity and Progression From Barrett’s Esophagus to Esophageal Adenocarcinoma. Clin Gastroenterol Hepatol, doi: 10.1016/j.cgh.2013.02.017
12.
Zurück zum Zitat Anaparthy R, Gaddam S, Kanakadandi V et al (2013) Association between length of Barrett’s esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol, doi: 10.1016/j.cgh.2013.05.007 Anaparthy R, Gaddam S, Kanakadandi V et al (2013) Association between length of Barrett’s esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol, doi: 10.1016/j.cgh.2013.05.007
13.
Zurück zum Zitat Hardikar S, Onstad L, Blount PL et al (2013) The role of tobacco, alcohol, and obesity in neoplastic progression to esophageal adenocarcinoma: a prospective study of Barrett’s esophagus. PLoS One 8: e52192PubMedCrossRef Hardikar S, Onstad L, Blount PL et al (2013) The role of tobacco, alcohol, and obesity in neoplastic progression to esophageal adenocarcinoma: a prospective study of Barrett’s esophagus. PLoS One 8: e52192PubMedCrossRef
14.
Zurück zum Zitat Wang JS, Canto MI (2010) Predicting neoplastic progression in Barrett’s esophagus. Ann Gastroentol Hepatol 1: 1–10PubMed Wang JS, Canto MI (2010) Predicting neoplastic progression in Barrett’s esophagus. Ann Gastroentol Hepatol 1: 1–10PubMed
15.
Zurück zum Zitat Bird-Lieberman EL, Dunn JM, Coleman HG et al (2012) Population-based study reveals new risk-stratification biomarker panel for Barrett’s esophagus. Gastroenterology 143: 927–35.e3PubMedCrossRef Bird-Lieberman EL, Dunn JM, Coleman HG et al (2012) Population-based study reveals new risk-stratification biomarker panel for Barrett’s esophagus. Gastroenterology 143: 927–35.e3PubMedCrossRef
16.
Zurück zum Zitat Nguyen DM, Richardson P, El-Serag HB (2010) Medications (NSAIDs, statins, proton pump inhibitors) and the risk of esophageal adenocarcinoma in patients with Barrett’s esophagus. Gastroenterology 138: 2260–2266PubMedCrossRef Nguyen DM, Richardson P, El-Serag HB (2010) Medications (NSAIDs, statins, proton pump inhibitors) and the risk of esophageal adenocarcinoma in patients with Barrett’s esophagus. Gastroenterology 138: 2260–2266PubMedCrossRef
17.
Zurück zum Zitat Falk GW, Buttar NS, Foster NR et al (2012) A combination of esomeprazole and aspirin reduces tissue concentrations of prostaglandin E(2) in patients with Barrett’s esophagus. Gastroenterology143: 917–26.e1 Falk GW, Buttar NS, Foster NR et al (2012) A combination of esomeprazole and aspirin reduces tissue concentrations of prostaglandin E(2) in patients with Barrett’s esophagus. Gastroenterology143: 917–26.e1
18.
Zurück zum Zitat Chang EY, Morris CD, Seltman AK et al (2007) The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Ann Surg 246: 11–21PubMedCrossRef Chang EY, Morris CD, Seltman AK et al (2007) The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Ann Surg 246: 11–21PubMedCrossRef
19.
Zurück zum Zitat Meining A (2004) The Munich Barrett follow up study: suspicion of Barrett’s oesophagus based on either endoscopy or histology only–what is the clinical significance? Gut 53: 1402–1407PubMedCrossRef Meining A (2004) The Munich Barrett follow up study: suspicion of Barrett’s oesophagus based on either endoscopy or histology only–what is the clinical significance? Gut 53: 1402–1407PubMedCrossRef
20.
Zurück zum Zitat Sharma P, Dent J, Armstrong D et al (2006) The development and validation of an endoscopic grading system for barrett’s esophagus: the prague C & M criteria. Gastroenterology 131: 1392–1399PubMedCrossRef Sharma P, Dent J, Armstrong D et al (2006) The development and validation of an endoscopic grading system for barrett’s esophagus: the prague C & M criteria. Gastroenterology 131: 1392–1399PubMedCrossRef
21.
Zurück zum Zitat Bennett C, Vakil N, Bergman J et al (2012) Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. 336–346 Bennett C, Vakil N, Bergman J et al (2012) Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. 336–346
22.
Zurück zum Zitat Wolfsen HC, Crook JE, Krishna M et al (2008) Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s esophagus. Gastroenterology 135: 24–31PubMedCrossRef Wolfsen HC, Crook JE, Krishna M et al (2008) Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s esophagus. Gastroenterology 135: 24–31PubMedCrossRef
23.
Zurück zum Zitat Sharma P, Hawes RH, Bansal A et al (2013) Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut 62: 15–21PubMedCrossRef Sharma P, Hawes RH, Bansal A et al (2013) Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut 62: 15–21PubMedCrossRef
24.
Zurück zum Zitat Curvers W, Baak L, Kiesslich R et al (2008) Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett’s esophagus. Gastroenterology 134: 670–679PubMedCrossRef Curvers W, Baak L, Kiesslich R et al (2008) Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett’s esophagus. Gastroenterology 134: 670–679PubMedCrossRef
25.
Zurück zum Zitat Giacchino M, Bansal A, Kim RE et al (2013) Clinical utility and interobserver agreement of autofluorescence imaging and magnification narrow-band imaging for the evaluation of Barrett’s esophagus: a prospective tandem study. Gastrointest Endosc, doi: 10.1016/j.gie.2013.01.029 Giacchino M, Bansal A, Kim RE et al (2013) Clinical utility and interobserver agreement of autofluorescence imaging and magnification narrow-band imaging for the evaluation of Barrett’s esophagus: a prospective tandem study. Gastrointest Endosc, doi: 10.1016/j.gie.2013.01.029
26.
Zurück zum Zitat Sturm MB, Joshi BP, Lu S et al (2013) Targeted imaging of esophageal neoplasia with a fluorescently labeled peptide: first-in-human results. Sci Transl Med 5: 184ra61PubMedCrossRef Sturm MB, Joshi BP, Lu S et al (2013) Targeted imaging of esophageal neoplasia with a fluorescently labeled peptide: first-in-human results. Sci Transl Med 5: 184ra61PubMedCrossRef
27.
Zurück zum Zitat Bajbouj M, Vieth M, Rösch T et al (2010) Probe-based confocal laser endomicroscopy compared with standard four-quadrant biopsy for evaluation of neoplasia in Barrett’s esophagus. Endoscopy 42: 435–440PubMedCrossRef Bajbouj M, Vieth M, Rösch T et al (2010) Probe-based confocal laser endomicroscopy compared with standard four-quadrant biopsy for evaluation of neoplasia in Barrett’s esophagus. Endoscopy 42: 435–440PubMedCrossRef
28.
Zurück zum Zitat Sharma P, Meining AR, Coron E et al (2011) Real-time increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. YMGE 74: 465–472 Sharma P, Meining AR, Coron E et al (2011) Real-time increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. YMGE 74: 465–472
29.
Zurück zum Zitat Tseng EE, Wu TT, Yeo CJ et al (2003) Barrett’s esophagus with high grade dysplasia: surgical results and long-term outcome–an update. J Gastrointest Surg 7: 164–170 (discussion170–171)PubMedCrossRef Tseng EE, Wu TT, Yeo CJ et al (2003) Barrett’s esophagus with high grade dysplasia: surgical results and long-term outcome–an update. J Gastrointest Surg 7: 164–170 (discussion170–171)PubMedCrossRef
30.
Zurück zum Zitat Shaheen NJ, Sharma P, Overholt BF et al (2009) Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 360: 2277–2288PubMedCrossRef Shaheen NJ, Sharma P, Overholt BF et al (2009) Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 360: 2277–2288PubMedCrossRef
31.
Zurück zum Zitat Pech O, Bollschweiler E, Manner H et al (2011) Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 254: 67–72PubMedCrossRef Pech O, Bollschweiler E, Manner H et al (2011) Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 254: 67–72PubMedCrossRef
32.
Zurück zum Zitat Pouw RE, Heldoorn N, Herrero LA et al (2011) Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases. Gastrointest Endosc 73: 662–668PubMedCrossRef Pouw RE, Heldoorn N, Herrero LA et al (2011) Do we still need EUS in the workup of patients with early esophageal neoplasia? A retrospective analysis of 131 cases. Gastrointest Endosc 73: 662–668PubMedCrossRef
33.
Zurück zum Zitat Pouw RE, Seewald S, Gondrie JJ et al (2010) Stepwise radical endoscopic resection for eradication of Barrett’s oesophagus with early neoplasia in a cohort of 169 patients. Gut 59: 1169–1177PubMedCrossRef Pouw RE, Seewald S, Gondrie JJ et al (2010) Stepwise radical endoscopic resection for eradication of Barrett’s oesophagus with early neoplasia in a cohort of 169 patients. Gut 59: 1169–1177PubMedCrossRef
34.
Zurück zum Zitat Vilsteren FGI van, Pouw RE, Seewald S et al (2011) Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut 60: 765–773PubMedCrossRef Vilsteren FGI van, Pouw RE, Seewald S et al (2011) Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut 60: 765–773PubMedCrossRef
35.
Zurück zum Zitat Pech O, Behrens A, May A et al (2008) 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 Barrett’s oesophagus. Gut 57: 1200–1206PubMedCrossRef Pech O, Behrens A, May A et al (2008) 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 Barrett’s oesophagus. Gut 57: 1200–1206PubMedCrossRef
36.
Zurück zum Zitat Neuhaus H, Terheggen G, Rutz EM et al (2012) Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrett’s esophagus. Endoscopy, doi: 10.1055/s-0032-1310155 Neuhaus H, Terheggen G, Rutz EM et al (2012) Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrett’s esophagus. Endoscopy, doi: 10.1055/s-0032-1310155
37.
Zurück zum Zitat Kim MP, Brown KN, Schwartz MR et al (2013) Advanced esophageal cancer in patients who underwent radiofrequency ablation for barrett esophagus with high-grade dysplasia. Innovations (Phila) 8: 17–22 Kim MP, Brown KN, Schwartz MR et al (2013) Advanced esophageal cancer in patients who underwent radiofrequency ablation for barrett esophagus with high-grade dysplasia. Innovations (Phila) 8: 17–22
38.
Zurück zum Zitat Haidry RJ, Dunn JM, Butt MA et al (o J) Radiofrequency ablation (RFA) and endoscopic mucosal resection for dysplastic barrett’s esophagus and early esophageal adenocarcinoma: outcomes of UK National Halo RFA Registry. Gastroenterology, doi: 10.1053/j.gastro.2013.03.045 Haidry RJ, Dunn JM, Butt MA et al (o J) Radiofrequency ablation (RFA) and endoscopic mucosal resection for dysplastic barrett’s esophagus and early esophageal adenocarcinoma: outcomes of UK National Halo RFA Registry. Gastroenterology, doi: 10.1053/j.gastro.2013.03.045
39.
Zurück zum Zitat Gupta M, Iyer PG, Lutzke L et al (2013) Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of barrett’s esophagus: results from a us multicenter consortium. Gastroenterology, doi: 10.1053/j.gastro.2013.03.008 Gupta M, Iyer PG, Lutzke L et al (2013) Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of barrett’s esophagus: results from a us multicenter consortium. Gastroenterology, doi: 10.1053/j.gastro.2013.03.008
40.
Zurück zum Zitat Phoa KN, Pouw RE, Vilsteren FGI van et al (2013) Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands Cohort Study. Gastroenterology, doi: 10.1053/j.gastro.2013.03.046 Phoa KN, Pouw RE, Vilsteren FGI van et al (2013) Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands Cohort Study. Gastroenterology, doi: 10.1053/j.gastro.2013.03.046
Metadaten
Titel
Update Barrett-Ösophagus
verfasst von
PD Dr. M. Anders
Publikationsdatum
01.11.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Gastroenterologie / Ausgabe 6/2013
Print ISSN: 2731-7420
Elektronische ISSN: 2731-7439
DOI
https://doi.org/10.1007/s11377-013-0811-1

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