Das Gallengangskarzinom: Von neuen Erkenntnissen der Epidemiologie zur Früherkennung

Zusammenfassung

Das Cholangiokarzinom (CCA) ist eine vergleichsweise seltene maligne Erkrankung des hepatobiliären Systems. Aufgrund der geringen Inzidenz der Erkrankung ist eine generelle Vorsorgeuntersuchung der gesamten Bevölkerung weder aus Ressourcen- noch aus Evidenzgründen zu empfehlen. In Westeuropa und in Deutschland stellen chronische Leberkrankungen wie die Leberzirrhose ursprünglicher Ätiologie sowie die PSC Hauptrisikofaktoren für die Entstehung des CCA dar. Diese Patientengruppen weisen das höchste Risiko auf, an einem CCA zu erkranken und sollten daher ähnlich der „HCC surveillance“ beim Hepatozellulären Karzinom engmaschig kontrolliert werden. Neue endoskopische Techniken wie die Cholangioskopie können insbesondere bei der Abklärung von unklaren Strikturen der extrahepatischen Gallenwege bei PSC-Patienten die Diagnostik unterstützen.

Eine große Herausforderung stellt die Zunahme der Insulinresistenz, des metabolischen Syndroms und damit einhergehend der massive Anstieg der Fallzahl an Patienten mit nicht-alkoholischer Fettleber (NAFLD) dar. Da Patienten mit Diabetes mellitus ein erhöhtes Risiko für die Erkrankung an einem CCA haben, wird es eine große Herausforderung darstellen unter dieser großen Anzahl an Patienten diejenigen zu identifizieren, die das höchste Risiko für die Erkrankung an einem CCA aufweisen, um sie dann Früherkennungsmaßnahmen zuzuführen.

Abstract

Cholangiocarcinoma is non-curable in many cases at establishing the diagnosis. New insights into epidemiology may promote screening of cholangiocarcinoma in a combination of risk scores, but today PSC is the only risk factor with an established screening recommendation.

Schlüsselwörter

Cholangiokarzinom - Epidemiologie - Primäre sklerosierende Cholangitis - Endoskopisch-retrograde cholangiopancreatographie ERCP - Metabolisches Syndrom

Keywords

cholangiocarcinoma - epidemiology - primary sclerosing cholangitis - endoscopic retrograde cholangiopancreatography (ERCP) - metabolic syndrome

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