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Update Barrett-Ösophagus

Update on Barrett’s esophagus

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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.

Abstract

Barrett’s esophagus (BE), the acquired replacement of squamous epithelium lining the distal esophagus by columnar epithelium containing goblet cells, is a consequence of chronic gastroesophageal reflux disease. Endoscopic surveillance aims at the timely recognition and treatment of patients developing neoplastic BE. Recently, several new modalities for the diagnosis and treatment of neoplastic BE have been introduced, e.g. virtual chromoendoscopy and radiofrequency ablation. In this article current knowledge on the clinical impact of these techniques will be discussed. Furthermore, this article gives an overview of recent findings concerning the development of BE and the malignant transformation.

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Literatur

  1. 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: 1946–1952

    Article  PubMed  Google Scholar 

  2. 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: 36–51

    Article  PubMed  CAS  Google Scholar 

  3. 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. 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: 1668–1673

    Article  PubMed  Google Scholar 

  5. 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: 1131–1136

    Article  PubMed  CAS  Google Scholar 

  6. Bollschweiler E, Wolfgarten E, Gutschow C et al (2001) Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 92: 549–555

    Article  PubMed  CAS  Google Scholar 

  7. Hvid-Jensen F, Pedersen L, Drewes AM et al (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 365: 1375–1383

    Article  PubMed  CAS  Google Scholar 

  8. 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)

    Article  PubMed  Google Scholar 

  9. Koop H, Schepp W, Müller-Lissner S et al (2005) Consensus Conference of the DGVS on gastroesophageal reflux. Z Gastroenterol 43: 163–164

    Article  PubMed  CAS  Google Scholar 

  10. Wani S (2012) Management of low-grade dysplasia in Barrett’s esophagus. Curr Opin Gastroenterol 28: 370–376

    Article  PubMed  Google Scholar 

  11. 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. 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. 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: e52192

    Article  PubMed  CAS  Google Scholar 

  14. Wang JS, Canto MI (2010) Predicting neoplastic progression in Barrett’s esophagus. Ann Gastroentol Hepatol 1: 1–10

    PubMed  Google Scholar 

  15. 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.e3

    Article  PubMed  CAS  Google Scholar 

  16. 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: 2260–2266

    Article  PubMed  Google Scholar 

  17. 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. 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: 11–21

    Article  PubMed  Google Scholar 

  19. 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: 1402–1407

    Article  PubMed  CAS  Google Scholar 

  20. 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: 1392–1399

    Article  PubMed  Google Scholar 

  21. 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. 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: 24–31

    Article  PubMed  Google Scholar 

  23. 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: 15–21

    Article  PubMed  Google Scholar 

  24. 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: 670–679

    Article  PubMed  Google Scholar 

  25. 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. 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: 184ra61

    Article  PubMed  CAS  Google Scholar 

  27. 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: 435–440

    Article  PubMed  CAS  Google Scholar 

  28. 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

    Google Scholar 

  29. 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)

    Article  PubMed  Google Scholar 

  30. Shaheen NJ, Sharma P, Overholt BF et al (2009) Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 360: 2277–2288

    Article  PubMed  CAS  Google Scholar 

  31. 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: 67–72

    Article  PubMed  Google Scholar 

  32. 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: 662–668

    Article  PubMed  Google Scholar 

  33. 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: 1169–1177

    Article  PubMed  Google Scholar 

  34. 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: 765–773

    Article  PubMed  Google Scholar 

  35. 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: 1200–1206

    Article  PubMed  CAS  Google Scholar 

  36. 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. 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

    Google Scholar 

  38. 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. 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. 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

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. Der Autor gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Interdisziplinäre Endoskopie, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    M. Anders

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Anders, M. Update Barrett-Ösophagus. Gastroenterologe 8, 541–550 (2013). https://doi.org/10.1007/s11377-013-0811-1

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