Tunneltechniken und flächige Resektionen im Oesophagus – Einsatzgebiete, Ergebnisse und Perspektiven

Zusammenfassung

Endoskopische submuköse Tunneltechniken im Gastrointestinaltrakt ermöglichen heute einen Zugang zur muskulären Wandschicht oder nach Eröffnung derselben einen Zugang zur umliegenden Körperhöhle, wie sie ansonsten nur von außen thorakoskopisch, mediastinoskopisch, laparoskopisch oder offen chirurgisch zu erreichen wäre. Im Rahmen von „Natural Orifice Transluminal Endoscopic Surgery“ (NOTES) wird diese Tunneltechnik als Z-förmiger, ventilartiger Zugangsweg genutzt, während die „Perorale Endoskopische Myotomie im Ösophagus“ (POEM) oder Magen die submukosale Durchtrennung der Muskulatur zum Ziel hat. Das „Submukosale Tunneln und endoskopische Resezieren“ (STER) nutzt den Tunnel, um Tumoren der Muscularis-propria-Schicht mucosageschützt zu excidieren und entlang des Tunnels abzutransportieren. Tunneltechniken im Rahmen der flächigen „Endoskopischen Submucosa-Dissektion“ schaffen einen submucosalen Tunnel, um unter Belassenen einer cranialen Aufhängung, ein zentrales, z.B. röhrenförmiges Mucosa-Resektat zu schaffen, das eine komplette histo-pathologische Aufarbeitung und klare onkologische Aussage schafft. Die verschiedenen Techniken werden beschrieben.

Abstract

Endoscopic submucosal tunneling techniques in the gastrointestinal tract nowadays allow an endoscopic access to the muscular wall layer itself or after its opening an access to the surrounding body cavity which otherwise would have only been possible on the thoracoscopic, mediastinoscopic, laparoscopic or open surgical route. In the context of “Natural Orifice Transluminal Endoscopic Surgery” (NOTES) this kind of tunneling technique is used as Z-shaped, valve-like access way. Per-Oral Endoscopic Myotomy in the esophagus (POEM) or stomach uses this access for a mucosa-protected transsection of the muscular layer for the teatment of motilty disorders. The so called “Submucosal Tunneling and Endoscopic Resection” technique (STER) uses the submucosal access way to excise tumors of the proper muscle layer under mucosal protection. The tumor is then removed via the submucosal channel. The endoscopic submucosal dissection technique uses tunneling for the creation of a central, e.g. tubular resection specimen in the esophagus which allows a complete histo-pathological work-up and clear oncologic statement. The different techniques are described.

Schlüsselwörter

Tunneltechniken - submuköse Tumoren - NOTES - Ösophagus - Myotomie - POEM

Key words

tunneling techniques - submucosal tumors - NOTES - esophagus - myotomy - POEM

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