Akutkomplikationen nach endoskopischer Resektion von Duodenaladenomen

Zusammenfassung

Durch die technischen Entwicklungen in den letzten Jahren haben die endoskopische Diagnostik und Therapie von Duodenaladenomen an Bedeutung gewonnen. Aufgrund des möglichen malignen Potenzials ist eine adäquate Therapie unerlässlich. Die endoskopische Resektion hat sich in den letzten Jahren als sichere und effiziente Therapieoption gezeigt, auch bei der Therapie größerer Adenome. Bisher konnte dies jedoch nur in Studien mit geringen Fallzahlen bestätigt werden. In unserer Klinik erfolgte über einen Zeitraum von 14 Jahren die Resektion von insgesamt 178 Duodenaladenomen, wobei sowohl sporadische Duodenaladenome als auch Adenome im Rahmen eines bekannten familiären Adenomatosis-Polyposis-Syndroms therapiert wurden. Das Hauptaugenmerk dieser retrospektiven Analyse lag auf den im Rahmen der Resektion auftretenden Akutkomplikationen. Die Rate schwerwiegender Komplikationen wie Majorblutungen oder Perforationen betrug 9 %. Weitere beobachtete Komplikationen waren Minorblutungen (15,7 %), analgetikapflichtige Schmerzen (6,7 %), Fieber (2,8 %) und die Entwicklung einer akuten Pankreatitis (0,6 %). Fassen wir unsere Erfahrungen mit der endoskopischen Therapie von Dünndarmadenomen zusammen, so sehen wir die endoskopische Therapie von Duodenaladenomen in den meisten Fällen als sichere und effiziente Alternative zur chirurgischen Therapie. Aufgrund der möglichen Komplikationen, v. a. bei größeren Adenomen über 2 cm Größe, sollte die Therapie unter stationären Bedingungen an erfahrenen Zentren durchgeführt werden.

Abstract

With the increasing technological development of endoscopy in recent years the diagnosis of and endoscopic therapy for duodenal adenomas has gained in importance. Due to its potentially malignant transformation an effective and safe therapy is necessary. The endoscopic resection has been shown to be safe and effective, even in cases of resection of large duodenal adenomas. Several studies have supported this thesis but are based on relatively small numbers of patients. In our clinic we have performed endoscopic resections of 178 duodenal adenomas over a period of 14 years, including sporadic duodenal adenomas as well as adenomas in familial polyposis syndromes. The aim of this retrospective analysis was to determine the acute complications associated with this technique. The rate of severe complications such as major bleeding or perforations was 9 %. Further complications were minor bleeding (15.7 %), pain needing treatment with analgesia (6.7 %), fever (2.8 %) and pancreatitis (0.6 %). Summing up our experience with the endoscopic resection of adenomas of the small bowel we also consider the endoscopic resection of duodenal adenomas in most cases as a safe and effective alternative to surgical therapy. Because of the potential complications and their management especially in the resection of large adenomas with a size more than 2 cm, the endoscopic resection should be performed on an inpatient basis in experienced centres.

Schlüsselwörter

Dünndarmblutung - familiäre adenomatöse Polyposis (FAP) - gastrointestinale Blutung

Key words

small bowel haemorrhage - familial adenomatous polyposis (FAP) - gastrointestinal haemorrhage

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