Management der hochgradigen Neoplasie der Barrett-Schleimhaut (High Grade Dysplasia)

 

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Zusammenfassung

Die hochgradige Neoplasie der Barrett-Schleimhaut (HGD) ist definiert als eine intraepitheliale Neoplasie im Rahmen der Metaplasie-Dysplasie-Karzinom-Sequenz des Barrett-Karzinoms. Der natürliche zeitliche Verlauf der malignen Entartung der HGD ist unbekannt, so dass Aussagen zum Risiko der Entwicklung eines invasiven Karzinoms nur eingeschränkt möglich sind. Das zentrale Problem der Behandlung der HGD liegt in den bisher nur unvollkommenen endoskopischen und histopathologischen Nachweismöglichkeiten, die die Sicherung der HGD innerhalb einer Barrett-Metaplasie erschweren. Trotz erheblicher Fortschritte bei der endoskopischen Identifikation der Läsionen sowie verbesserter Nachweisverfahren auf histologischer Ebene bleibt die Diagnostik der HGD kontrovers. Die prognostischen und diagnostischen Unsicherheiten spiegeln sich in der Breite der zur Verfügung stehenden therapeutischen Optionen wider. Diese reichen von regelmäßiger endoskopischer Kontrolle über Ablationsverfahren bis hin zur komplexen thorakoabdominalen Ösophagusresektion. In der vorliegenden Arbeit werden aktuelle diagnostische und therapeutische Strategien zusammenfasst und ein Algorithmus zur Behandlung der HGD erarbeitet.

Abstract

High-grade neoplasia of Barrett's esophagus (HGD) is defined as an intraepithelial neoplastic condition occurring within the metaplasia-dysplasia-adenocarcinoma sequence of Barrett's carcinoma. As the natural history of HGD remains unknown, a patient's actual risk for the development of invasive malignancy is difficult to define. Main drawbacks of the management of HGD are the shortcomings of the endoscopic and histologic diagnostic tools. Despite recent advances of diagnostic tests, the identification of HGD remains controversial. Diagnostic and prognostic uncertainties are reflected by the multitude of therapeutic options that range from endosocopic surveillance to complex thoracoabdominal surgery. The present paper resumes actual diagnostic and therapeutic strategies, an algorithm for the treatment of HGD is proposed by the authors.

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Dr. med. Christian A. Gutschow

Klinik und Poliklinik für Viszeral- und Gefäßchirurgie, Universität zu Köln

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50931 Köln

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