Zusammenfassung
GRUNDLAGEN: Bei Patienten mit Refluxkrankheit findet sich oft ein kurzstreckiger Barrett-Ösophagus, in dem auch ein Adenokarzinom entstehen kann. METHODIK: Bericht über 5 Fälle von Adenokarzinom der Speiseröhre in einem kurzstreckigen Barrett-Ösophagus (inkl. Radiodiagnostik, Funktionsdiagnostik, Histopathologie und Operationen). ERGEBNISSE: Bei 4 Männern und einer Frau (mittleres Alter 58 Jahre) und über im Mittel 9 Jahre dauernden Refluxsymptomen fanden sich kleine Ösophagus-Adenokarzinome des intestinalen Typs in einem kurzstreckigen Barrett-Ösophagus: beschränkt auf die Mukosa (n = 1), bis in die muscularis propria (n = 2) und weiter fortgeschritten (n = 2). In 4 Fällen lagen bereits Lymphknotenmetastasen vor. Es wurden jeweils eine video-assistierte Ösophagusresektion mit Magenhochzug und zervikaler Anastomose durchgeführt (keine Mortalität, 3× Anastomosendehiszenz zervikal). Ein Patient verstarb 10 Monate nach OP an einem Rezidiv eines Nierenkarzinoms, einer 62 Monate nach OP an einem Herzinfarkt. Ein Patient verstarb 38 Monate postoperativ am Rezidiv des Ösophaguskarzinoms. Zwei Patienten leben 18 bzw. 40 Monate nach OP. SCHLUSSFOLGERUNGEN: Auch in einem kurzstreckigen Barrett-Ösophagus kann ein Adenokarzinom entstehen, weshalb eine regelmäßige endoskopische und bioptische Nachsorge unter PPI-Therapie bei Refluxkrankheit empfohlen wird.
Summary
BACKGROUND: The endoscopic findings of short-segment Barrett's esophagus (SSBE) is a frequent diagnosis among patients with a long-standing history of gastroesophageal reflux. PURPOSE: To describe the clinical and pathologic findings in a small group of patients with SSBE, who developed an Adenocarcinoma. METHODS: Five patients were included in this study, 3 of them from a prospective endoscopic follow-up of patients with SSBE. A complete clinical, radiological and endoscopic evaluation was performed, and 24-h pH monitoring and esophageal manometry were also performed. Surgical procedure consisted in all of a transhiatal videoassisted esophagectomy with gastric pull up and cervical anastomosis and two-field lymphadenectomy. RESULTS: Four patients were men and 1 a woman with a mean age of 58 years. Symptoms of gastroesophageal reflux were present with a mean of 9 years. Radiological studies revealed the existence of a carcinoma in only one patient (20%). Endoscopic evaluation demonstrated a small carcinoma on the SSBE in 60%. In 3 patients 24 h pH monitoring revealed a severe acid reflux. All tumours corresponded to a tubular adenocarcinoma of the intestinal type. One patient had a mucosal carcinoma, 2 up to the muscularis propria and 2 had an advanced carcinoma. Lymph node metastases were absent in one patient. There was no operative mortality and postoperative morbidity corresponded to 3 leakages of the cervical anastomosis. Two patients had an associated renal carcinoma. One patient died 10 months after surgery due to recurrence of renal carcinoma and one died 62 months after surgery due to heart infarction. Only 1 patient died due to recurrence 38 months after surgery. Two patients are alive 18 and 40 months after operation. CONCLUSIONS: Patients with SSBE may develop an adenocarcinoma during their natural evolution. Therefore, an endoscopic surveillance during chronic medical treatment is mandatory.
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Csendes, A., Braghetto, I., Burdiles, P. et al. Adenocarcinoma developing in short-segment Barrett's esophagus: analysis of 5 patients and review of the literature. Eur Surg 39, 359–363 (2007). https://doi.org/10.1007/s10353-007-0355-z
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DOI: https://doi.org/10.1007/s10353-007-0355-z