[Barrett's esophagus carcinoma]

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.