[Curative Treatment of Esophageal Carcinoma - Disease, Diagnostics, Therapy in 2022]. / Kurative Therapie des Ösophaguskarzinomes.

Curative Treatment of Esophageal Carcinoma - Disease, Diagnostics, Therapy in 2022 Abstract. Surgical resection remains the gold standard for non-metastatic carcinoma of the lower and middle third of the esophagus. Locally advanced tumors (T3) are pretreated neoadjuvantly (radiochemotherapy) or perioperatively (chemotherapy). A differentiated primary staging and an interdisciplinary case presentation are of essential importance today. The individual risk assessment, the pre-habilitation and the individualized treatment play a major role. Clinically, the further advancement of access minimization - through laparoscopic/thoracoscopic and robot-assisted procedures and the associated reduction of access trauma - as well as the treatment of this entity in high volume centers are clearly in the foreground. For cervical carcinomas definitive radiotherapy is often the better alternative, both for tumor biological reasons and for reasons of the increase in complications during surgery.

[GERD and Barett: Natural Course of One Disease - Update Diagnostics and Therapy]. / GERD und Barrett.

GERD and Barett: Natural Course of One Disease - Update Diagnostics and Therapy Abstract. The gastroesophageal reflux disease (GERD) represents a relatively frequent condition, which clinically includes orocervical, thoracic and abdominal complaints. GERD is defined as pathological gastroesophageal acidic reflux, which consecutively leads to mucosal damage of the esophagus such as reflux esophagitis. The most common symptom of GERD is heartburn but GERD symptoms include various complaints, which need to be considered in diagnosis and therapy. Besides endoscopy, barium swallow, pH metry and manometry are counted among the routine diagnostics for GERD patients. For therapy, dietary and lifestyle measures come along with medication such as proton pump inhibitors (PPI) as daily medication and antacids on demand. It has been demonstrated that anti-reflux surgery, minimally invasive fundoplication or magnet augmentation of the lower esophageal sphincter, produces an equal and lasting effect on GERD compared to PPI. Surgery is preferred in case of large hiatal hernia of voluminous reflux. Success of therapy is given if esophageal exposure to acid is reduced, which shows in remission of esophagitis or which can be demonstrated through pH-metry control. Additionally, improvement of quality of life stands in the focus of GERD treatment, which is to be considered for every therapeutic step. Barrett esophagus represents a subtype of GERD with rising incidence in Western countries. As potential precancerous lesion, the Barrett's esophagus is to be diagnosed early and needs to undergo a risk stratified surveillance in order to prevent dysplasia or carcinoma. Patients with low grade dysplasia, high grade dysplasia or early Barrett's carcinoma should be treated endoscopically. Soon artificial intelligence might contribute to improvement of Barrett's esophagus surveillance and treatment.