Zusammenfassung
Das Spektrum interventioneller endosonografischer Techniken hat sich in den letzten
10 Jahren enorm entwickelt. Weltweit nimmt das Interesse an neuen Einsatzgebieten
für den therapeutischen endoskopischen Ultraschall zu. Die Methode erlaubt durch ihre
Kombination der Endoskopie mit der hochauflösenden Sonografie eine Erweiterung des
endoskopischen interventionellen Spektrums. Dies kann in vielen Fällen operative Interventionen
ersparen und potenziell gefährliche Eingriffe für unsere Patienten sicherer machen.
Im Beitrag werden neben der endosonografisch geführten Therapie von pankreatischen
Pseudozysten, Abszessen und Nekrosen neue Techniken in der EUS-geführten internen
Gallengangsdrainage und Pankreasgangdrainage besprochen und ihre Relevanz im klinischen
Alltag unter Einbeziehung aktueller Literaturdaten kritisch gewürdigt.
Abstract
Endoscopic ultrasonography (EUS)-guided interventions are an essential tool for complex
(such as combined or subsequent) therapeutic measures and are, in current as well
as future endoscopy, an indispensable part of modern gastroenterology. Longitudinal
EUS scanners allow one to puncture transluminally both mediastinal and abdominal lesions
which cannot be approached with other techniques. Using the EUS-guided puncture of
such pathological lesions, it becomes possible to perform further, more advanced endoscopic
interventions which thus become safer as well as more efficient and are associated
with a lower complication rate compared with conventional endoscopic or even surgical
interventions. A crucial aspect in interventional EUS is the adequate, less traumatic
treatment of pancreatic pseudocysts. The transluminal route for interventions spanning
from the approach to the placement of a drainage for abscesses and/or necroses is
considerably easier under EUS-guidance, including better outcomes. Novel approaches
and interventions are the internal EUS-guided insertion of a transluminal (from the
upper GI tract) I) cholangiodrainage in patients with malignant obstruction of the
bile duct but no option to achieve sufficient conventional cholangiodrainage with
ERC or PTC, II) pancreaticodrainage in symptomatic patients with enlarged pancreatic
duct -/+ pancreatic fistula postoperatively or in patients with chronic pancreatitis,
which may be considered new therapeutic strategies with non-operative intentions and/or
low invasiveness.
Schlüsselwörter
gastroenteropankreatische Tumoren - Endosonografie - Interventionen
Key words
gastro-entero-pancreatic tumours - endosonography - interventions
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