Palliative endoskopische Therapie bei Klatskin-Tumoren

In 70% der neu diagnostizierten Klatskin-Tumoren kann lediglich ein palliatives Therapiekonzept angeboten werden. Hierbei spielen endoskopische Therapien eine wichtige Rolle. In diesem Beitrag werden die wichtigsten endoskopischen Therapieoptionen, inklusive Stentimplantation und intraduktale Ablation, ihre technischen Besonderheiten und ihre Ergebnisse, beleuchtet.

Kernaussagen

• Endoskopische Techniken spielen eine wichtige Rolle in der palliativen Therapie von fortgeschrittenen Klatskin-Tumoren.

• Die endoskopische Stentimplantation mittels ERCP (endoskopische retrograde Cholopankreatografie) ist die üblichste Methode zur palliativen Galleableitung.

• Die selbstexpandierenden Metallgitterstents (SEMS) haben Vorteile im Vergleich zu den Plastikstents, und ihr Einsatz sollte vor allem bei Klatskin-Tumoren primär erwogen werden.

• Die palliative Galleableitung bei Klatskin-Tumoren setzt eine individualisierte, interdisziplinäre Therapiestrategie voraus. So kann beispielsweise der ideale Zugangsweg, die Auswahl der Stents (beschichtet oder unbeschichtet) und das Ausmaß der Drainage (unilateral, bilateral oder segmental) individuell angepasst werden.

• Falls die endoskopische, transpapilläre Galleableitung nicht möglich ist, stellt eine transkutane, transgastrale oder transduodenale Drainage eine gute Alternative dar.

• Intraduktale, ablative Verfahren, inklusive photodynamische Therapie (PDT) und Radiofrequenzablation (RFA), verbessern die Stentoffenheitsrate und verlängern das Gesamtüberleben.

Schlüsselwörter

biliäre Drainage - Gallengangstent - endosonografische Punktion - photodynamische Therapie - Radiofrequenzablation - Gallenableitung

Publication History

Article published online:
23 May 2022

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