Der Gastroenterologe

, Volume 12, Issue 5, pp 388–393 | Cite as

Klinische Diagnostik und endoskopische Therapie von Barrett-Ösophagus und Frühkarzinomen

Schwerpunkt
First Online:

Zusammenfassung

Die endoskopische Diagnostik und Therapie des Barrett-Ösophagus und von frühen Neoplasien stellt noch immer eine Herausforderung für Endoskopiker dar. Frühe Barrett-Neoplasien sind häufig nur schwierig zu detektieren und abzugrenzen, sodass in den Leitlinien weiterhin die 4‑Quadranten-Biopsie als diagnostische Methode der Wahl empfohlen wird. Chromoendoskopische Verfahren, wie die Essigsäurefärbung, können allerdings die Diagnostik deutlich erleichtern. Die Therapie der Wahl im Fall einer frühen Barrett-Neoplasie stellt in den meisten Fällen die endoskopische Resektion mit einem Multiband-Ligatur-System dar. Nach kompletter Resektion des neoplastischen Areals muss immer eine Ablation des Rest-Barrett-Ösophagus erfolgen, um die Rezidivwahrscheinlichkeit zu minimieren. Hierfür werden vor allem die Radiofrequenzablation und die Argon-Plasma-Koagulation eingesetzt.

Schlüsselwörter

Ösophaguskarzinom Gastrointestinale Endoskopie Narrow Band Imaging Endoskopische Submukosadissektion Argon-Plasma-Koagulation  

Clinical diagnosis and endoscopic treatment of Barrett esophagus and early cancers

Abstract

Endoscopic diagnosis and treatment of early Barrett’s neoplasia are still a challenge for endoscopists. Early lesions are difficult to detect and to delineate; therefore, four-quadrant biopsies are still recommended over chromoendoscopy like acetic acid or virtual chromoendoscopy (narrow band imaging [NBI; Olympus, Hamburg, Germany], Blue Light Imaging [BLI; Fujifilm, Tokyo, Japan], i‑scan [Pentax, Hamburg, Germany]). The treatment of choice in high-grade dysplasia and mucosal Barrett’s cancer is complete endoscopic resection of the lesion with the “suck-and-cut” technique (Inoue cap or multiband ligation device) followed by ablation of the remaining Barrett’s mucosa. Endoscopic submucosal dissection has not been shown to be superior to piecemeal endoscopic resection and is therefore only recommended in case of bulky lesions >15 mm with suspicion for submucosal invasion. The primary ablation technique is radiofrequency ablation, especially in longer Barrett segments. Argon plasma coagulation is often used in smaller Barrett tongues of islands.

Keywords

Esophageal cancer Gastrointestinal endoscopy Narrow band imaging Endoscopic submucosal dissection Argon plasma coagulation  
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Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

O. Pech gibt folgende Interessenskonflikte an: Vortragshonorare von Boston Scientific, Medtronic, Fujifilm, Olympus, Norgine, AbbVie.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Koop H, Fuchs KH, Labenz J, Lynen Jansen P, Messmann H, Miehlke S, Schepp W, Wenzl TG (2014) Mitarbeiter der Leitliniengruppe. S2K-Leitlinie Gastroösophageale Refluxerkrankung. Z Gastroenterol 52(11):1299–1346. doi: 10.1055/s-0034-1385202 CrossRefPubMedGoogle Scholar
  2. 2.
    Weusten B, Bisschops R, Coron E, Dinis-Ribeiro M, Dumonceau JM, Esteban JM, Hassan C, Pech O, Repici A, Bergman J, di Pietro M (2017) Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy 49(2):191–198. doi: 10.1055/s-0042-122140 CrossRefPubMedGoogle Scholar
  3. 3.
    Pohl H, Welch HG (2005) The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 97(2):142–146. doi: 10.1093/jnci/dji024 CrossRefPubMedGoogle Scholar
  4. 4.
    Sharma P, Dent J, Armstrong D, Bergman JJ, Gossner L, Hoshihara Y et al (2006) The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 131(5):1392–1399. doi: 10.1053/j.gastro.2006.08.032 CrossRefPubMedGoogle Scholar
  5. 5.
    Gupta N, Gaddam S, Wani SB, Bansal A, Rastogi A, Sharma P (2012) Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointest Endosc 76(3):531–538. doi: 10.1016/j.gie.2012.04.470 CrossRefPubMedGoogle Scholar
  6. 6.
    Coletta M, Sami SS, Nachiappan A, Fraquelli M, Casazza G, Ragunath K (2016) Acetic acid chromoendoscopy for the diagnosis of early neoplasia and specialized intestinal metaplasia in Barrett’s esophagus: a meta-analysis. Gastrointest Endosc 83(1):57–67.e1. doi: 10.1016/j.gie.2015.07.023 CrossRefPubMedGoogle Scholar
  7. 7.
    Song J, Zhang J, Wang J, Guo X, Yu S, Wang J, Liu Y, Dong W (2015) Meta-analysis of the effects of endoscopy with narrow band imaging in detecting dysplasia in Barrett’s esophagus. Dis Esophagus 28(6):560–566. doi: 10.1111/dote.12222 CrossRefPubMedGoogle Scholar
  8. 8.
    Sharma P, Bergman JJ, Goda K, Kato M, Messmann H, Alsop BR, Gupta N, Vennalaganti P, Hall M, Konda V, Koons A, Penner O, Goldblum JR, Waxman I (2016) Development and validation of a classification system to identify high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus using narrow-band imaging. Gastroenterology 150(3):591–598. doi: 10.1053/j.gastro.2015.11.037 CrossRefPubMedGoogle Scholar
  9. 9.
    Hvid-Jensen F, Pedersen L, Drewes AM, Sørensen HT, Funch-Jensen P (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 365(15):1375–1383. doi: 10.1056/nejmoa1103042 CrossRefPubMedGoogle Scholar
  10. 10.
    Duits LC, Phoa KN, Curvers WL, ten Kate FJ, Meijer GA, Seldenrijk CA, Offerhaus GJ, Visser M, Meijer SL, Krishnadath KK, Tijssen JG, Mallant-Hent RC, Bergman JJ (2015) Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut 64(5):700–706. doi: 10.1136/gutjnl-2014-307278 CrossRefPubMedGoogle Scholar
  11. 11.
    Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, Fullarton G, Di Pietro M, Ravi N, Visser M, Offerhaus GJ, Seldenrijk CA, Meijer SL, ten Kate FJ, Tijssen JG, Bergman JJ (2014) Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA 311(12):1209–1217. doi: 10.1001/jama.2014.2511 CrossRefPubMedGoogle Scholar
  12. 12.
    Ell C, May A, Gossner L, Pech O, Guenter E, Mayer G et al (2000) Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 118(4):670–677. doi: 10.1016/s0016-5085(00)70136-3 CrossRefPubMedGoogle Scholar
  13. 13.
    Pech O, May A, Manner H, Behrens A, Pohl J, Weferling M, Hartmann U, Manner N, Huijsmans J, Gossner L, Rabenstein T, Vieth M, Stolte M, Ell C (2014) Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 146(3):652–660.e1. doi: 10.1053/j.gastro.2013.11.006 CrossRefPubMedGoogle Scholar
  14. 14.
    Pech O, Behrens A, May A, Nachbar L, Gossner L, Rabenstein T 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(9):1200–1206. doi: 10.1136/gut.2007.142539 CrossRefPubMedGoogle Scholar
  15. 15.
    Manner H, Rabenstein T, Braun K, May A, Pech O, Pohl J et al (2014) Ablation of residual Barrett’s epithelium after endoscopic resection: a randomized long-term follow-up study of argon plasma coagulation vs. surveillance (APE study). Endoscopy 46(1):6–12. doi: 10.1055/s-0033-1358813 PubMedGoogle Scholar
  16. 16.
    Phoa KN, Pouw RE, Bisschops R, Pech O, Ragunath K, Weusten BL, Schumacher B, Rembacken B, Meining A, Messmann H, Schoon EJ, Gossner L, Mannath J, Seldenrijk CA, Visser M, Lerut T, Seewald S, ten Kate FJ, Ell C, Neuhaus H, Bergman JJ (2016) Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut 65(4):555–562. doi: 10.1136/gutjnl-2015-309298 CrossRefPubMedGoogle Scholar
  17. 17.
    Manner H, Pech O, Heldmann Y, May A, Pohl J, Behrens A, Gossner L, Stolte M, Vieth M, Ell C (2013) Efficiacy, safety and long-term results of endoscopic treatment for early-stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol 11(6):630–635. doi: 10.1016/j.cgh.2012.12.040 CrossRefPubMedGoogle Scholar
  18. 18.
    Bollschweiler E, Baldus SE, Schröder W, Prenzel K, Gutschow C, Schneider PM, Hölscher AH (2006) High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy 38(2):149–156. doi: 10.1055/s-2006-924993 CrossRefPubMedGoogle Scholar
  19. 19.
    Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH (2015) Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 47(9):829–854. doi: 10.1055/s-0034-1392882 CrossRefPubMedGoogle Scholar
  20. 20.
    Terheggen G, Horn EM, Vieth M, Gabbert H, Enderle M, Neugebauer A, Schumacher B, Neuhaus H (2016) A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut 66(5):783–793. doi: 10.1136/gutjnl-2015-310126 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.Klinik für Gastroenterologie und interventionelle EndoskopieDarmzentrum Barmherzige Brüder RegensburgRegensburgDeutschland

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