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Endoskopie heute 2006; 19(4): 242-247
DOI: 10.1055/s-2006-955200
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Endoskopische Tumortherapie beim Magenfrühkarzinom - Möglichkeiten und Grenzen

Endoscopic Therapy for Early Gastric Cancer - Potentials and LimitsK. Deinert1 , H. Neuhaus1
  • 1Medizinische Klinik, Evangelisches Krankenhaus Düsseldorf
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Publication History

Publication Date:
26 January 2007 (online)

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Zusammenfassung

Die endoskopische Resektion von Magenfrühkarzinomen ist in Japan ein Standardverfahren geworden. Dabei hängt das Ergebnis nicht alleine von der Intervention ab. Die lokale endoskopische Therapie setzt sich viel mehr aus vier Eckpfeilern zusammen: der Selektion geeigneter Patienten, der Wahl des adäquaten Resektionsverfahrens, der postinterventionellen Stratifizierung und der Nachbeobachtung. Unter Berücksichtigung dieser Aspekte werden in Japan bei niedriger Morbidität und extrem geringer Mortalität potenziell kurative lokale Resektionsraten von über 90 % erreicht. Sowohl in Bezug auf die Komplikationen als auch in Bezug auf die Effektivität müssen sich die endoskopischen Verfahren mit den etablierten chirurgischen Resektionen messen lassen. Der Vorteil des endoskopischen Vorgehens liegt in der niedrigeren Komplikationsrate bei Erhalt der gastralen Funktion und der Lebensqualität. Daher gewinnen die lokalen Verfahren insbesondere bei älteren Patienten mit Komorbiditäten an Attraktivität. Ob die Daten aus Japan, einem Land mit einer höheren Inzidenz an Magenfrühkarzinomen, auf Deutschland übertragbar sind, bleibt derzeit ungeklärt.

Abstract

Endoscopic resection of early gastric cancer (EGC) is gaining increasing interest in western countries since mostly Japanese publications demonstrate a high rate of curative resection. The procedure is complex and results are dependent not only on the endoscopic part. Factors like adequate patient selection, choice of local resection technique, follow-up and patient stratification can affect the clinical outcome. Considering these factors Japanese investigators were able to achieve local cure in more than 90 % of patients with low morbidity and mortality rates. These new therapeutic procedures have to be compared to standard surgical treatment options with regard to efficacy and safety. The most important advantage of endoscopic therapy of EGC is a low rate of complications while preserving gastric function, with no impact on quality of life. Currently, it remains unclear whether the Japanese data are transferable to Germany, a country with a much lower incidence of early gastric cancer.

Schlüsselwörter

Magenfrühkarzinom - endoskopische Therapie - endoskopische Submukosadissektion

Key words

early gastric cancer - endoscopic therapy - endoscopic submucosal dissection (ESD)

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Professor Dr. med. H. Neuhaus

Evangelisches Krankenhaus Düsseldorf

Kirchfeldstr. 40

40217 Düsseldorf

Email: medizinischeklinik@evk-duesseldorf.de

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