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Barrett-Ösophagus

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Barrett’s esophagus

An update

Zusammenfassung

Der Barrett-Ösophagus (BÖ) als Komplikation einer chronischen gastroösophagealen Refluxerkrankung (GERD) stellt die präkanzeröse Bedingung für das Adenokarzinom des distalen Ösophagus dar. Das sog. Barrett-Karzinom zeigt in der westlichen Hemisphäre eine deutliche Inzidenzsteigerung. Die Definition des BÖ ist derzeit im Fluss: Trotz guter Argumente für eine rein endoskopische Diagnose wird in Deutschland und in den USA weiterhin der Becherzellnachweis gefordert. Der wichtigste Risikofaktor für die Karzinomentstehung ist der Nachweis von dysplastischen Epithelveränderungen, wobei neuerdings eine Subklassifizierung in einen häufigeren adenomatösen („intestinalen“) und einen nichtadenomatösen („gastral-foveolären“) Typ vorgenommen wird. Goldstandard für die Dysplasiediagnose ist nach wie vor die HE-Färbung. Die histologische Dysplasiediagnose ist mit einer nicht unerheblichen Interobservervariabilität belastet, insbesondere bei der Abgrenzung einer niedriggradigen Dysplasie von entzündlich-reaktiven Veränderungen und einer hochgradigen Dysplasie vom Adenokarzinom. Aktuelle Daten zeigen, dass die Übereinstimmung bei Verwendung endoskopischer Resektate anstatt von Biopsien deutlich besser ist. Aufgrund der klinischen Konsequenzen sollte obligat eine externe Zweitbeurteilung bei jeder Dysplasiediagnose erfolgen. Bei der lokalen Therapie von Frühkarzinomen durch endoskopische Resektion muss im histologischen Befund eine Risikoabschätzung für eine lymphogene Metastasierung angeben werden.

Abstract

Barrett’s esophagus (BE), a well-known complication of gastroesophageal reflux disease (GERD), constitutes a precancerous condition for adenocarcinoma of the distal esophagus. The so-called Barrett’s carcinoma shows increasing incidences in countries of the western hemisphere; new data, however, indicate that the rise in incidence is not quite as dramatic as previously assumed. The definition of BE is currently changing: despite good reasons for a purely endoscopic definition of BE, goblet cells are still mandatory for this diagnosis in Germany and the USA. Dysplastic changes in the epithelium are the most important risk factor for the development of Barrett’s adenocarcinoma and recently dysplasia was subclassified into a more frequent adenomatous (intestinal) and a non-adenomatous (gastric-foveolar) types. The gold standard for diagnosing dysplasia is still H&E staining. The histological diagnosis of dysplasia is still encumbered by a significant interobserver variability, especially regarding the differentiation between low grade dysplasia and inflammatory/reactive changes and the discrimination between high grade dysplasia and adenocarcinoma. Current data, however, show much higher interobserver agreement in endoscopic resection specimens than in biopsies. Nevertheless, the histological diagnosis of dysplasia should be corroborated by an external second opinion because of its clinical consequences. In endoscopic resections of early Barrett’s adenocarcinoma, the pathological report has to include a risk stratification for the likelihood of lymphogenic metastases.

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Abbreviations

AGA:

 American Gastroenterological Association

BÖ:

  Barrett-Ösophagus

CED:

  Chronisch-entzündliche Darmerkrankung

GERD:

 Gastroösophageale Refluxerkrankung

HGD/HGIEN:

Hochgradige Dysplasie bzw. intraepitheliale Neoplasie

LGD/LGIEN:

Niedriggradige Dysplasie bzw. intraepitheliale Neoplasie

ÖGJ:

Ösophagogastrale Junktion

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Baretton, G., Aust, D. Barrett-Ösophagus. Pathologe 33, 5–16 (2012). https://doi.org/10.1007/s00292-011-1541-0

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Schlüsselwörter

  • Barrett-Ösophagus
  • Gastroösophageale Refluxerkrankung
  • Intestinale Metaplasie
  • Dysplasie
  • Adenokarzinom des Ösophagus

Keywords

  • Barrett’s esophagus
  • Gastroesophageal reflux disease
  • Intestinal metaplasia
  • Dysplasia
  • Esophageal adenocarcinoma