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Interventionelle Endosonographie

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Interventional endosonography

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Zusammenfassung

Endosonographische interventionelle Verfahren haben Einzug in die klinische Routine gefunden. Hauptsächlich hat sich die Methode der Drainage von peripankreatischen Flüssigkeitsansammlungen bzw. pankreatischen Walled-off-Nekrosen durchgesetzt. Sie ist in Deutschland in allen gastroenterologischen Zentren verfügbar und hat die Therapie der Komplikationen entzündlicher Pankreaserkrankungen verändert und die Prognose erheblich verbessert. Die Methode der Plexusblockade bzw. -neurolyse hat sich im klinischen Alltag ebenfalls etabliert, ist jedoch aufgrund der limitierten Wirkungsweise im Allgemeinen von untergeordneter Bedeutung.

Kompliziertere Drainageverfahren von obstruktiven Veränderungen der Gallenwege und des Pankreasganges sind endosonographisch möglich, aber nur für spezielle Indikationen geeignet. Aus diesem Grunde sollten sie nach wie vor nur ausnahmsweise und in speziellen Zentren eingesetzt werden. Tumorablative Verfahren sind besonders am Pankreas endosonographisch zwar leicht durchführbar, werden aber aufgrund der stark eingeschränkten Indikation oder unklaren Studienlage Einzelfällen vorbehalten bleiben. Gleiches gilt für den Einsatz der Endosonographie bei endovaskulären Therapien.

Abstract

Endosonographic interventional procedures have become established in the clinical routine, mainly in the methods for drainage of peripancreatic fluid accumulation and pancreatic walled-off necrosis. These methods are available in all gastroenterology centers in Germany and have altered the therapy of complications of inflammatory pancreatic diseases as well as substantially improving the prognosis. The methods of plexus blockade and plexus neurolysis have also become established in the clinical routine but are of subordinate importance due to the generally limited mode of action.

Complicated drainage procedures for obstructive alterations to the bile ducts and pancreatic ducts are possible endosonoscopically but are only suitable for special indications. For this reason these procedures should only be used in exceptional situations and in specialized centers. On the contrary, tumor ablative procedures are particularly easily carried out endosonoscopically in the pancreas but due to the severely limited indications are reserved for unclear study conditions in individual cases. The same applies to the use of endosonography with respect to endovascular therapy.

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Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Correspondence to Dr. M. Hocke.

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Hocke, M., Will, U. & Dietrich, C. Interventionelle Endosonographie. Gastroenterologe 8, 100–105 (2013). https://doi.org/10.1007/s11377-012-0721-7

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Schlüsselwörter

  • Akute/postakute Pankreatitis
  • Peripankreatischen Flüssigkeitsansammlungen
  • Abgegrenzte Pankreasnekrosen
  • Plexusneurolyse
  • Drainageverfahren

Keywords

  • Acute/postacute pancreatitis
  • Peripancreatic fluid accumulation
  • Walled-off pancreatic necrosis (WOPN)
  • Plexus neurolysis
  • Drainage procedures