Endoluminale Therapie von Magenadenomen und Frühkarzinomen

Zusammenfassung

Die Diagnose eines Magenfrühkarzinoms hat durch die Entwicklung von neuen lokalen endoskopischen Resektionsmethoden erheblich zugenommen. Vorteil dieser Methoden im Vergleich zur Chirurgie ist die niedrige Morbidität, die Organerhaltung und damit die größere Lebensqualität. Voraussetzung für alle endoskopischen Verfahren ist eine entsprechende Patientenselektion in high - und low Risikogruppen bezüglich Infiltrationstiefe und Lymphknotenmetastasenrisiko. Verschiedene endoskopische Techniken wurden für die Mukosaresektion entwickelt. Als Abtragungsverfahren werden die endoskopische Resektion mittels Schlinge oder Kappe bei Läsionen bis 2 cm favorisiert, bei > 2 cm ist aufgrund des hohen Rezidivrisikos bei Piece-meal-Technik die endoskopische Dissektion (ESD) gefordert. Die ESD zählt in Japan zu den Standardverfahren zur Therapie des Magenfrühkarzinoms, ob sich die Daten auf Europa übertragen lassen, bleibt abzuwarten. Das Verfahren zeichnet sich durch zeitintensive Untersuchungen, höhere Komplikationsraten und eine hohe Lernkurve aus. Möglicherweise wird durch Verbesserungen der Geräte und des Zubehörs eine Vereinfachung des Verfahrens erzielt.

Abstract

The diagnosis of early stomach cancer has become very important since the development of new endoscopic local resection techniques. Advantages of these procedures compared to surgery are the maintenance of organ, low morbidity and more quality of life. Patients need to be selected for local therapy by assessment of high and low risk criteria regard to depth of infiltration and risk of lymph node metastasis. Several endoscopic techniques have been advocated for mucosal resection. Endoscopic resection by snare or cup for lesions up to 2 cm size is the most common procedure, lesions larger than 2 cm should be resected by ESD because high risk of recurrence by piece meal technique has been reported. In Japan ESD is the standard procedure for the therapy of early gastric cancer. It is still unclear whether these good data are transferable to Europe. The procedure is time consuming and shows a higher risk of complications and a high learning curve. Possibly further refinements of endoscopes and technical equipments may simplify the procedure that ESD become the first option for the treatment of early gastric cancer.

Schlüsselwörter

Magenfrühkarzinom - endoskopische Submukosadissektion (ESD) - En-bloc-Resektion

Key words

early gastric cancer - endoscopic submocosa dissection (ESD) - en-bloc resection

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