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Endoskopie heute 2006; 19(4): 222-227
DOI: 10.1055/s-2006-942311
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Barrett-Ösophagus: Endoskopische Diagnose und Therapie

Barrett's Esophagus: Endoscopical Diagnosis and TherapyA. Meining1 , T. Rösch2
  • 1II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München
  • 2Zentrale Interdisziplinäre Endoskopie, Charite Universitätsmedizin Berlin, Campus Virchow
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Publication History

Publication Date:
26 January 2007 (online)

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Zusammenfassung

In den letzten Jahren gab es enorme Anstrengungen in der Verbesserung der Diagnose und Therapie des Barrett-Ösophagus. Durch moderne bildgebende Verfahren bis zur Darstellung zellulärer Strukturen in-vivo ist es möglich, schon während der Endoskopie eine Gewebstypisierung durchzuführen. Aufgrund des häufig fokalen Auftretens der Barrett-Metaplasie, aber auch der Barrett-Neoplasie besteht jedoch auch unter Ausschöpfung aller moderner Verfahren nach wie vor das Risiko eines Sampling-Errors. Für die tägliche Praxis kann daher bis auf Weiteres nicht auf den histopathologischen Goldstandard mittels 4-Quadrantenbiopsie verzichtet werden. Im Bereich der Barrett-Therapie ist inzwischen der Einsatz minimalinvasiver endoskopisch-ablativer Verfahren Leitlinien-gerecht fest etabliert. Häufig ist jedoch individuell eine Kombination mehrerer - z. T. unterschiedlicher - Verfahren bei multifokalen Auftreten neoplastischer Veränderungen notwendig. Zukünftige Studien werden zeigen, was das optimale endoskopische bzw. interventionelle Verfahren zur totalen Barrett-Ablation ohne Nachwirkungen (Strikturen, Rezidive) sein wird.

Abstract

The endoscopical diagnosis and treatment of Barrett's esophagus has dramatically improved the last years. Today, modern imaging methodology enables an almost histological image of the mucosa in-vivo during the endoscopic procedure. Nevertheless, despite all these modern methods there is still a sampling bias for detection of Barrett's metaplasia and Barrett's neoplasia. Hence, standard histopathology after four-quadrant-random biopsy still has to be regarded as the gold standard for daily routine practise. For therapy of Barrett's esophagus, minimal invasive therapy by the use of endoscopical ablation of the mucosa has been established in published guidelines. However, an individual approach by combining different methods is often requested for treatment of multifocal neoplasia. It will be the aim of future studies to find the ideal endoscopical therapy for complete ablation of Barrett's esophagus without potential side effects (strictures, recurrence of neoplasia).

Schlüsselwörter

Barrett-Ösophagus - Diagnose - Therapie - Endoskopie

Key words

Barrett's esophagus - diagnosis - therapy - endoscopy

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PD Dr. med. A. Meining

II. Medizinische Klinik · Klinikum rechts der Isar der TU München

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81675 München

Phone: 0 89/4 14 00

Fax: 0 89/41 40 49 05

Email: Alexander.Meining@lrz.tum.de