Zusammenfassung
Die endoskopische Submukosadissektion (ESD) wurde Ende der 1990er-Jahre in Japan entwickelt. Mittlerweile hat sie sich auch in Europa an zahlreichen Zentren fest etabliert. Sie stellt eine En-bloc-Schleimhautresektionstechnik zur Behandlung von Frühkarzinomen mit einem Durchmesser >1 cm sowie von flächigen Präkanzerosen dar, die mit bisherigen Schlingenresektionstechniken onkologisch oft nur unbefriedigend in mehreren Partikeln oder mit unsicherem lateralem Sicherheitsabstand abgetragen werden konnten. Bei der ESD wird die Läsion nach zirkulärer Markierung und großflächiger Unterspritzung mit einem Sicherheitsabstand von etwa 5 mm umschnitten und nachfolgend im Niveau der Submukosa mit einem 1–3 mm langen Diathermiemesserchen abgelöst. Die Methode stellt erhöhte technische Ansprüche an die Erfahrung des Untersuchers und ist zeitaufwendiger als die Schlingenresektion. In zahlreichen Studien zeigt sich jedoch eine klare Überlegenheit hinsichtlich R0-Resektionsrate und Lokalrezidivrate. In der vorliegenden Arbeit geben wir einen aktuellen Überblick über die ESD im oberen und unteren Gastrointestinaltrakt und zeigen Perspektiven des Verfahrens auf.
Abstract
Endoscopic submucosal dissection (ESD) was developed in Japan but has now also become permanently established in various centers in Europe. ESD is an endoscopic en bloc mucosal resection technique for the treatment of early cancers with a diameter >1 cm and also superficial precancerous lesions, which could only be removed unsatisfactorily in several fragments or with uncertain lateral safety margins using previous loop excision procedures. Using ESD a lesion is excised after circular marking and generous submucosal injection with a safety margin of approximately 5 mm and subsequently resected at the level of the submucosa with a 1-3 mm short diathermic knife. ESD requires high technical skills in interventional endoscopy and is more time-consuming than snare resection techniques. However, numerous studies have shown a clear superiority for ESD with respect to the R0 resection rate and the local recurrence rate. The present article gives a current review of the use of ESD in the upper and lower gastrointestinal tract and demonstrates perspectives of the procedure.
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Danksagung
Wir danken Herrn Prof. Naoisha Yahagi, Tokyo, und Frau Prof. Hitomi Minami, Nagasaki, und Kollegen für die sorgfältige Prüfung der Paris- und LST-Präparateklassifikation (Abb. 3, 4, 5, 10, 11).
Interessenkonflikt
Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Prof. Hochberger: kein Interessenkonflikt in Hinsicht auf diesen Beitrag. (Sonstige: Ovesco GmbH, Tübingen, AR 2009–2012; Falk Foundation, Freiburg, VT).
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Hochberger, J., Köhler, P., Kruse, E. et al. Endoskopische Submukosadissektion. Internist 54, 287–301 (2013). https://doi.org/10.1007/s00108-012-3179-2
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DOI: https://doi.org/10.1007/s00108-012-3179-2