[Barrett esophagus--esophageal carcinoma: surgical therapy]

Barrett's oesophagus is an acquired condition that occurs as a consequence of gastrooesophageal reflux. Continuous exposure of the Barrett's epithelium to gastric juice may lead from a low-grade to a high-grade dysplasia and subsequently to an invasive adenocarcinoma. Therefore, the first goal of treatment for patients with Barrett's oesophagus is the prevention of reflux to eliminate the risk of a progression to dyplasia and cancer. In contrast to medical treatment antireflux surgery restores the low oesophageal sphincter, abolishes reflux of gastric contents into the oesophagus and ends the repetitive injury to both the metaplastic and normal oesophageal mucosa. In case of Barrett's carcinoma of the distal oesophagus a radical transhiatal oesophagectomy with systematic abdominal and mediastinal lymph node dissection is the procedure of choice. After forming a gastric tube the reconstruction is done by a transposition of stomach through the posterior mediastinum and a cervical anastomosis. Because of substantial complications and long-term side effects the need for extensive resection in patients with early tumour stage (pT1) is questionable. Therefore, a limited resection of distal oesophagus and proximal stomach with two-field lymphadenectomy and jejunal interposition is an attractive alternative in early Barrett's carcinoma providing a low morbidity and mortality and resulting in a 90% chance of cure in patients without lymph node metastasis.