Messmann H
III Medizinische Klinik, Klinikum Augsburg.
Praxis (Bern 1994). 2006 Jun 21;95(25-26):1029-35. doi: 10.1024/0369-8394.95.25.1029.
The incidence of Barrett's esophagus, long segment as well as short segment, has increased over the last few years. One major reason for this was the increasing number of endoscopies. However there is a simultaneous increase of Barrett's adenocarcinoma in the Western world, while the number of squamous epithelium cancer decreases. Besides improved endoscopic diagnosis other exogenous factors such as nutrition, reflux or adipositas play an important role. Due to available data it is clear that the risk of Barrett's esophagus has been overestimated, mainly because of a publication bias. The risk of a Barrett's esophagus carcinoma has been published with 0.5%/year. The U.S. and German guidelines do not recommend screening endoscopies for the general population, however for those with a long-lasting reflux disease for several years. The diagnosis of Barrett's esophagus is made endoscopically and histologically, this means 4 quadrant biopsies every 1-2 cm are gold standard. Staining with methylene blue or acetic acid in combination with zoom endoscopy may improve the diagnosis. In patients with proven Barrett's esophagus regular surveillance endoscopies depending on the presence of intraepithelial neoplasia are recommended. While patients with Barrett's esophagus and no or with low grade intraepithelial neoplasia need only surveillance, those with high grade intraepithelial neoplasia should be treated. EMR is a promising treatment of visible lesions, which is similar effective as surgery but with a lower morbidity and mortality. Non visible lesions can be treated promisingly by PDT. Similar to high grade intraepithelial neoplasia mucosal cancer can also be treated endoscopically. However, submucosal cancer needs surgery.
在过去几年中，长段和短段巴雷特食管的发病率均有所上升。其主要原因之一是内镜检查数量的增加。然而，在西方世界，巴雷特腺癌的发病率同时上升，而鳞状上皮癌的数量则有所下降。除了内镜诊断的改善外，营养、反流或肥胖等其他外部因素也起着重要作用。根据现有数据，很明显巴雷特食管的风险被高估了，主要是由于发表偏倚。巴雷特食管癌的发病风险已公布为每年0.5%。美国和德国的指南不建议对普通人群进行内镜筛查，但建议对患有多年持续性反流疾病的人群进行筛查。巴雷特食管的诊断通过内镜和组织学检查进行，这意味着每1 - 2厘米进行4象限活检是金标准。亚甲蓝或醋酸染色结合放大内镜检查可能会改善诊断。对于已确诊巴雷特食管的患者，建议根据上皮内瘤变的情况定期进行内镜监测。巴雷特食管且无或有低级别上皮内瘤变的患者仅需监测，而高级别上皮内瘤变的患者则应接受治疗。内镜黏膜切除术（EMR）是一种有前景的可见病变治疗方法，其效果与手术相似，但发病率和死亡率较低。不可见病变可通过光动力疗法（PDT）进行有效治疗。与高级别上皮内瘤变类似，黏膜癌也可通过内镜治疗。然而，黏膜下癌需要手术治疗。
