Endoskopische Interventionsmöglichkeiten bei Tumoren der Papille

Zusammenfassung

Hintergrund: Bei den selten auftretenden Papillentumoren unterscheidet man benigne von malignen Neoplasien. Diagnostische Methoden zur Erkennung von Papillentumoren reichen von nicht-invasiven bildgebenden Verfahren wie der Abdomensonografie, der Computertomografie und der MRCP (Magnetresonanz-Cholangio-Pankreatikografie) bis hin zu endoskopischen Methoden (Ösophago-Gastro-Duodenoskopie, Seitblick-Duodenoskopie, Endosonografie, intraduktaler Ultraschall, ERCP, Cholangioskopie). Letztere gelten nach wie vor zu den Methoden der Wahl, wobei in der Regel heute immer eine Kombination der einzelnen Untersuchungstechniken zu fordern ist.

Material / Methoden: Selektive Literaturrecherche und deskriptive Übersicht der Literaturergebnisse. 

Ergebnisse: Die Behandlungsmethode der Wahl bei lokal begrenzten, benignen Papillentumoren (LGN-Adenom) ist die endoskopische Papillektomie, wohingegen bei fortgeschrittenen Papillentumoren (HGN-Adenom / Tis / Karzinom) eine chirurgische Therapie indiziert ist. In ausgewählten Fällen (extraduktales Tumorwachstum) ist unter Umständen auch bei Frühkarzinomen eine endoskopische Papillektomie möglich.

Diskussion: Mit dieser Arbeit soll sowohl dem klinisch tätigen Chirurgen als auch Gastroenterologen eine Hilfestellung für die einzusetzende Diagnostik sowie die daraus resultierende Therapie bezüglich Papillenadenome und -karzinome gegeben werden.

Schlussfolgerung: Die Art der Behandlung von Papillentumoren richtet sich in erster Linie nach der Dignität, der Morphologie des Befundes und dem Wachstumsmuster (extraduktal vs. intraduktal).

Abstract

Background: Ampullary tumours are rare and can be separated in benign and malignant lesions. There are non-invasive diagnostic methods in order to detect ampullary tumours like abdominal ultrasound, computed tomography and MRCP (magnetic resonance cholangiopancreaticography) as well as invasive methods, e. g., gastroscopy, duodenoscopy, endosonography, intraductal ultrasound, ERCP and cholangioscopy. Endoscopy is the method of choice for this indication, whereas a combination of the different diagnostic methods is common.

Material and Methods: A selective literature research with descriptive survey has been carried out.

Results: The standard method to treat benign tumours of the papilla is endoscopic papillectomy. For malignant tumours surgery is preferred. But in some certain circumstances it is also possible to treat carcinomas of the papilla endoscopically.

Discussion: This overview should assist surgeons and endoscopists to choose the right diagnostic approach and to treat adenomas as well as carcinomas of the Papilla of Vater appropriately.

Conclusion: The treatment of papilla tumours depends primarily on the dignity, the morphology of the findings and the extension of the tumour (extraductal vs. intraductal).

Schlüsselwörter

Adenom - Papilla Vateri - Pankreastumor - endoskopische Intervention

Key words

adenoma - Papilla of Vater - pancreatic tumour - endoscopic intervention

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