Der Gastroenterologe

, Volume 8, Issue 2, pp 127–133

Barrett-Ablation

Wie, wann, warum?
Schwerpunkt
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Zusammenfassung

Die endoskopische Therapie von frühen Neoplasien des Barrett-Ösophagus und deren Vorstufen ist etabliert und wird in Techniken zur endoskopischen Resektion und in Verfahren zur Ablation unterteilt. Zur Prävention von Rezidiven oder Entwicklung von metachronen Neoplasien besteht nach fokaler endoskopischer Resektion früher Neoplasien die Indikation zur kompletten Eradikation der verbliebenen Barrett-Mukosa. Die Radiofrequenzablation ist aufgrund der hohen Effektivität bei geringer Komplikationsrate, technisch guter Anwendbarkeit, Erhalt der Funktionsfähigkeit des Ösophagus und anscheinend dauerhaftem Therapieerfolg aktuell das Verfahren der Wahl in der Ablation des Barrett-Ösophagus bei ausgewählten Patienten mit frühen Neoplasien oder in der Kombination aus primärer Resektion und additiver Ablation. Die Argonplasmakoagulation besitzt einen Stellenwert in der Therapie kleiner Areale residualer nichtneoplastischer Barrett-Schleimhaut nach fokaler Resektion. Die Ablation von nichtneoplastischem Barrett-Ösophagus stellt aktuell keine Indikation dar und sollte nur im Rahmen von Studien zur Evaluation möglicher Risikofaktoren für eine Karzinomentwicklung erwogen werden.

Schlüsselwörter

Barrett-Ösophagus Barrett-Frühkarzinome Ablationstechniken Radiofrequenzablation (RFA) Argonplasmakoagulation (APC) 

Ablation of Barrett’s esophagus

How, when, why?

Abstract

Endoscopic therapy is well established in the treatment of early Barrett’s neoplasia and can be divided into techniques for endoscopic resection and methods for ablation of Barrett’s esophagus. After focal resection of early neoplasia complete eradication of residual Barrett’s mucosa is indicated for the prevention of recurrences or metachronous neoplasia. Radiofrequency ablation is currently the best available ablation technique in well selected patients because it is safe and highly effective, has low complication rates, preserves the functional integrity of the esophagus, is easy to apply and generally shows lasting therapeutic success. Argon plasma coagulation plays a role in the ablation of small areas of residual non-dysplastic Barrett’s mucosa after endoscopic resection. The ablation of non-dysplastic Barrett’s esophagus is not recommended and should only be considered within clinical trials for the evaluation of independent risk factors for malignant progression.

Keywords

Barrett’s esophagus Dysplasia Ablation technique Radiofrequency ablation (RFA) Argon plasma coagulation (APC) 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Medizinische Klinik, Abt. für GastroenterologieEvangelisches Krankenhaus DüsseldorfDüsseldorfDeutschland

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