Endoskopische Tunnelungsverfahren bei Achalasie und Gastroparese

Zusammenfassung

Seit der Erstpublikation der peroralen endoskopischen Myotomie (POEM) durch Haruhiro Inoue et al. im Jahr 2008 in Japan haben sich verschiedene neuartige endoskopische Verfahren etabliert, welche nach iatrogener Schaffung eines submukosalen Tunnels als „neuen Raum“ durchgeführt werden [1]. Über den künstlich gebildeten Zugangsweg in der Tela submucosa können unter sorgfältiger Schonung der obersten Schleimhautschicht Interventionen im Bereich der Muskelschicht von Ösophagus und Magen durchgeführt werden [2]. Diese umfassen z. B. neben der Myotomie der Ösophagusmuskulatur bei Achalasie (POEM) die Durchtrennung des Pylorus bei Gastroparese (Antropyloromyotomie, G-POEM). Weitere Einsatzgebiete sind die Spaltung des Zenker-Divertikels in POEM-Technik („Z-POEM“) sowie die Entfernung subepithelialer Tumoren (STER: submukosale Tunnelung, endoskopische Resektion). Der langfristige Therapieerfolg (mit > 80 % Ansprechen) dieser innovativen Verfahren ist v. a. bei der Achalasie mittlerweile durch kontrollierte Studien belegt [2] [3] [4] [5] [6].

Abstract

Since the first publication of peroral endoscopic myotomy (POEM) by Haruhiro Inoue et al. in 2008 in Japan, various novel endoscopic procedures have been established, which are performed after iatrogenic creation of a submucosal tunnel as a „new space“ [1]. Through the artificially formed access in the tela submucosa, interventions in the muscular layer of the esophagus and stomach can be performed while carefully sparing the mucosal layer [2]. These include, peroral myotomy of the esophageal muscle layer in patients with achalasia (POEM) and myotomy of the pylorus in patients with gastroparesis (antropyloromyotomy, G-POEM). Further indications include splitting of Zenker diverticulum in POEM technique („Z-POEM“) as well as the removal of subepithelial tumors (STER: submucosal tunneling, endoscopic resection). The long-term therapeutic success (with > 80 % response) of these innovative procedures has now been proven by controlled studies, especially in achalasia [2] [3] [4] [5] [6].

Schlüsselwörter

Achalasie - Gastroparese - G-POEM - POEM

Key Words

achalasia - gastroparesis - G-POEM - POEM

Publication History

Article published online:
30 April 2021

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