Skip to main content
SpringerLink
Log in

Endoskopische Palliation bei Ösophagus- und Bronchialkarzinomen

Endoscopic palliation of esophageal and bronchial carcinomas

  • Schwerpunkt
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die Lumenverlegung durch Tumoren führt bei Bronchialkarzinomen zu einer Verlegung der Atemwege mit Luftnot und am Ösophagus zu Schluckstörungen. Sowohl am Ösophagus als auch an den Atemwegen sind selbstexpandierende Stents zur Wiederherstellung des Lumens etabliert und führen zu einer Symptomverbesserung. Am Bronchialsystem ist aufgrund anatomischer Bedingungen, insbesondere bei Prozessen der Hauptkarina, die Implantation wesentlich anspruchsvoller als am Ösophagus. Am Ösophagus ergeben sich insbesondere bei hochzervikalen Tumorstenosen und distalen Stenosen technische Schwierigkeiten. Moderne Stententwicklungen haben hier die Versorgung weiter verbessern können. Bei hochzervikalen Ösophagustumoren, aber auch bei grenzüberschreitendem Tumorwachstum mit Fistelbildung ist eine gemeinsame interdisziplinäre gastroenterologisch-pneumolgische Behandlung notwendig.

Abstract

Luminal obstruction from tumor growth can in relation to bronchial carcinoma lead to airway and/or esophageal obstruction in breathlessness or swallowing difficulties respectively. Self-expanding stents have become an established method of restoring luminal patency in both the esophagus and central airways, leading to significant symptomatic improvement. Due to anatomical constraints particularly in processes around the tracheal carina, stent implantation within the bronchial system often poses greater difficulty than within the esophagus. Technical difficulties do however arise in the esophagus, specifically in relation to stenotic high-cervical tumors, as well as distal stenosis. In this regard, advances in stent development have resulted in significantly improved outcomes with modern stents. In high-cervical esophageal tumors as well as locally invasive tumors with evidence of tracheobronchial fistulae a shared interdisciplinary care between the gastroenterology and pulmonary teams is necessary for a satisfactory outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Bethge N, Sommer A, Vakil N (1997) A prospective trial of self-expanding metal stents in the palliation of malignant esophageal strictures near the upper esophageal sphincter. Gastrointest Endosc 45: 300–303

    Article  CAS  PubMed  Google Scholar 

  2. Bower MR, Martin RC (2009) Nutritional management during neoadjuvant therapy for esophageal cancer. J Surg Oncol 100: 82–87

    Article  PubMed  Google Scholar 

  3. Boxem T, Muller M, Venmans B et al. (1999) Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study. Chest 116: 1108–1112

    Article  CAS  PubMed  Google Scholar 

  4. Breitenbucher A, Chhajed PN, Brutsche MH et al. (2008) Long-term follow-up and survival after ultraflex stent insertion in the management of complex malignant airway stenoses. Respiration 75: 443–449

    Article  PubMed  Google Scholar 

  5. Cavaliere S, Venuta F, Foccoli P et al. (1996) Endoscopic treatment of malignant airway obstructions in 2,008 patients. Chest 110: 1536–1542

    Article  CAS  PubMed  Google Scholar 

  6. Chhajed PN, Baty F, Pless M et al. (2006) Outcome of treated advanced non-small cell lung cancer with and without central airway obstruction. Chest 130: 1803–1807

    Article  PubMed  Google Scholar 

  7. Colt HG, Harrell JH (1997) Therapeutic rigid bronchoscopy allows level of care changes in patients with acute respiratory failure from central airways obstruction. Chest 112: 202–206

    Article  CAS  PubMed  Google Scholar 

  8. Dumot JA, Greenwald BD (2008) Argon plasma coagulation, bipolar cautery and cryotherapy: ABC’s of ablative techniques. Endoscopy 40: 1026–1032

    Article  CAS  PubMed  Google Scholar 

  9. Enzinger PC, Mayer RJ (2003) Esophageal cancer. N Engl J Med 349: 2241–2252

    Article  CAS  PubMed  Google Scholar 

  10. Freitag L, Eicker K, Donovan T, Dimov D (1995) Mechanical properties of airway stents. J Bronchology 2: 270–278

    Article  Google Scholar 

  11. Gottlieb J, Fuehner T, Dierich M et al. (2009) Are metallic stents really safe? A long term analysis in lung transplant recipients. Eur Respir J 34: 1417–1422

    Article  CAS  PubMed  Google Scholar 

  12. Herth F, Becker HD, LoCicero J et al. (2001) Successful bronchoscopic placement of tracheobronchial stents without fluoroscopy. Chest 119: 1910–1912

    Article  CAS  PubMed  Google Scholar 

  13. Homs MY, Steyerberg EW, Eijkenboom WM et al. (2004) Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet 364: 1497–1504

    Article  PubMed  Google Scholar 

  14. Karakoca Y, Karaagac G, Aydemir C, Caner C (2008) A new endoluminal resection technique and device: resector balloon. Ann Thorac Surg 85: 628–631

    Article  PubMed  Google Scholar 

  15. Krimsky WS, Broussard JN, Sarkar SA, Harley DP (2009) Bronchoscopic spray cryotherapy: Assessment of safety and depth of airway injury. J Thorac Cardiovasc Surg [Epub ahead of print]

  16. Lunn W, Garland R, Ashiku S et al. (2005) Microdebrider bronchoscopy: a new tool for the interventional bronchoscopist. Ann Thorac Surg 80: 1485–1488

    Article  PubMed  Google Scholar 

  17. Mangar S, Slevin N, Mais K, Sykes A (2006) Evaluating predictive factors for determining enteral nutrition in patients receiving radical radiotherapy for head and neck cancer: a retrospective review. Radiother Oncol 78: 152–158

    Article  PubMed  Google Scholar 

  18. McArdle JR, Gildea TR, Mehta AC (2005) Balloon bronchoplasty: its indications, benefits and complications. J Bronchology Interventional Pulmonology 12: 123–127

    Google Scholar 

  19. Mehta AC (2008) AERO self-expanding hybrid stent for airway stenosis. Expert Rev Med Devices 5: 553–557

    Article  CAS  PubMed  Google Scholar 

  20. Miyazawa T, Yamakido M, Ikeda S et al. (2000) Implantation of ultraflex nitinol stents in malignant tracheobronchial stenoses. Chest 118: 959–965

    Article  CAS  PubMed  Google Scholar 

  21. Morice RC, Ece T, Ece F, Keus L (2001) Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest 119: 781–787

    Article  CAS  PubMed  Google Scholar 

  22. Ohnmacht GA, Allen MS, Cassivi SD et al. (2006) Percutaneous endoscopic gastrostomy risks rendering the gastric conduit unusable for esophagectomy. Dis Esophagus 19: 311–312

    Article  CAS  PubMed  Google Scholar 

  23. Reddy C, Majid A, Michaud G et al. (2008) Gas embolism following bronchoscopic argon plasma coagulation: a case series. Chest 134: 1066–1069

    Article  PubMed  Google Scholar 

  24. Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (2008) Krebs in Deutschland 2003–2004, Häufigkeiten und Trends, 6. Aufl. http://www.ekr.med.uni-erlangen.de/GEKID/Doc/kid2008.pdf

  25. Saad CP, Murthy S, Krizmanich G, Mehta AC (2003) Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis. Chest 124: 1993–1999

    Article  PubMed  Google Scholar 

  26. Schumann C, Hetzel M, Babiak AJ et al. (2009) Endobronchial tumor debulking with a flexible cryoprobe for immediate treatment of malignant stenosis. J Thorac Cardiovasc Surg [Epub ahead of print]

  27. Shepherd FA, Crowley J, Van Houtte P et al. (2007) The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the tumor, node, metastasis classification for lung cancer. J Thorac Oncol 2: 1067–1077

    Article  PubMed  Google Scholar 

  28. Speiser BL, Spratling L (1993) Remote afterloading brachytherapy for the local control of endobronchial carcinoma. Int J Radiat Oncol Biol Phys 25: 579–587

    CAS  PubMed  Google Scholar 

  29. Sreedharan A, Harris K, Crellin A et al. (2009) Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev CD005048

  30. Vanbiervliet G, Piche T, Caroli-Bosc FX et al. (2005) Endoscopic argon plasma trimming of biliary and gastrointestinal metallic stents. Endoscopy 37: 434–438

    Article  CAS  PubMed  Google Scholar 

  31. Verschuur EM, Kuipers EJ, Siersema PD (2007) Esophageal stents for malignant strictures close to the upper esophageal sphincter. Gastrointest Endosc 66: 1082–1090

    Article  PubMed  Google Scholar 

  32. Verschuur EM, Repici A, Kuipers EJ et al. (2008) New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol 103: 304–312

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Keine Angaben.

Author information

Authors and Affiliations

  1. Klinik für Pneumologie/OE 6870, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    J. Gottlieb

  2. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    J. Wedemeyer

Authors
  1. J. Gottlieb
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Wedemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Gottlieb.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gottlieb, J., Wedemeyer, J. Endoskopische Palliation bei Ösophagus- und Bronchialkarzinomen. Internist 51 (Suppl 1), 237–245 (2010). https://doi.org/10.1007/s00108-009-2502-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-009-2502-z

Schlüsselwörter

Keywords

Search

Navigation