[Barrett esophagus--esophageal carcinoma: conservative therapy and observation]

Chronic acid reflux is strongly associated with cancer of the esophagogastric junction and the main reason for the development of specialised intestinalised metaplasia in the esophagus (Barrett's esophagus). Endoscopic surveillance, therefore, is mandatory for long-segment Barrett's esophagus as well as short segment Barrett's. Videoendoscopy with four quadrant random biopsies are standard and new diagnostic tools like chromoendoscopy with methylene blue, magnifying endoscopy or fluorescence detection may turn out to be helpful. Differential surveillance strategies according to the recommendations of the American College of Gastroenterology and the Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen should be performed for medical and cost-efficiency reasons. Local endoscopic therapy of early cancer and high-grade dysplasia in Barrett's esophagus comprises three different methods: endoscopic mucosal resection (EMR), semiselective, athermal photodynamic therapy (PDT) and thermal techniques such as KTP- or Nd:YAG-laser and argon-plasma coagulation. All endoscopic methods have low morbidity and mortality rates compared to esophageal resection and therefore are an attractive alternative treatment option. Endoscopic mucosal resection is the treatment of choice for all localizable and circumscribed lesions, because the resected specimen can be classified with regard to the histopathological grading, complete resection and submucosal involvement, especially in view of patients who are surgical candidates. PDT is the best local treatment option for multifocal, not localizable or large superficial lesions, as large areas can be treated in a single therapeutic session. Thermal procedure are mainly auxiliary methods for the optimization of EMR or PDT. The shortterm and intermediate results of our studies appear to be promising in view of the high complete local remission rates in combination with the low morbidity and mortality.