Zusammenfassung
Die Möglichkeiten der interventionellen Endoskopie haben in den letzten Jahrzehnten rasante Fortschritte erzielt. Auch in der palliativen Therapie haben sich durch neue endoskopische Methoden deutliche Verbesserungen ergeben. Der vorliegende Artikel gibt einen Überblick über die interventionellen endoskopischen Möglichkeiten, aber auch Grenzen bei Malignomen des Gastrointestinaltrakts. In der Regel handelt es sich um Eingriffe, bei denen mittels Stents die natürliche Passage des Magendarmtrakts oder der Gallenwege wiederhergestellt wird. Technische Weiterentwicklungen, insbesondere endosonographische Techniken, haben neue Zugangswege und Therapieansätze ermöglicht. Auch ablative Verfahren wie die Radiofrequenzablation im Gallengang kommen im palliativen Setting zum Einsatz. Um die klinische Entscheidungsfindung zu ermöglichen, werden die unterschiedlichen Verfahren im Kontext ihrer Wirksamkeit, Risiken und Grenzen beschrieben.
Abstract
Interventional endoscopy has seen significant progress during recent decades. Also in palliative medicine have these advances improved the endoscopic treatment modalities for tumor patients. This article aims to provide an overview of interventional endoscopic techniques but also highlight their limitations in gastrointestinal cancer. In most cases, stents are used to restore intestinal passage or biliary flow. Technical advances, particularly in endosonography, have enabled new access routes for biliary drainage and gastric outlet obstruction. Furthermore, ablative techniques such as radiofrequency ablation are routinely used in inoperable palliative patients with biliary stenosis. In order to enable clinical decision-making, the various methods are described in the context of their effectiveness, risks, and limitations.
Literatur
Soliman YY, Kundranda M, Kachaamy T (2024) Endoscopic palliative therapies for esophageal cancer. Gastrointest Endosc Clin N Am 34:91–109
Enzinger PC, Mayer RJ (2003) Esophageal cancer. N Eng J Med 349:2241–2252
Adamson D, Blazeby J, Porter C et al (2021) Palliative radiotherapy combined with stent insertion to reduce recurrent dysphagia in oesophageal cancer patients: the ROCS RCT. Health Technol Assess 25:1–144
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
Spaander MCW, van der Bogt RD, Baron TH et al (2021) Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) guideline – update 2021. Endoscopy 53:751–762
Iwasaki H, Mizushima T, Suzuki Y et al (2017) Factors that affect stent-related complications in patients with malignant obstruction of the esophagus or gastric cardia. Gut Liver 11:47–54
Wang C, Wei H, Li Y (2020) Comparison of fully-covered vs partially covered self-expanding metallic stents for palliative treatment of inoperable esophageal malignancy: a systematic review and meta-analysis. BMC Cancer 20:73
Park JH, Song HY, Shin JH et al (2015) Migration of retrievable expandable metallic stents inserted for malignant esophageal strictures: incidence, management, and prognostic factors in 332 patients. AJR Am J Roentgenol 204:1109–1114
Jena A, Chandnani S, Jain S et al (2023) Efficacy of endoscopic over-the-scope clip fixation for preventing migration of self-expandable metal stents: a systematic review and meta-analysis. Surg Endosc 37:3410–3418
Pandit S, Samant H, Morris J et al (2019) Efficacy and safety of standard and anti-reflux self-expanding metal stent: a systematic review and meta-analysis of randomized controlled trials. World J Gastrointest Endosc 11:271–280
Jeurnink SM, Steyerberg EW, van Hooft JE et al (2010) Dutch SUSTENT study group. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 71:490–499
van Wanrooij RLJ, Vanella G, Bronswijk M et al (2022) Endoscopic ultrasoundguided gastroenterostomy versus duodenal stenting for malignant gastric outlet obstruction: an international, multicenter, propensity score-matched comparison. Endoscopy 54:1023–1031
Boghossian MB, Funari MP, De Moura DTH et al (2021) EUS-guided gastroenterostomy versus duodenal stent placement and surgical gastrojejunostomy for the palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis. Langenbecks Arch Surg 406:1803–1817
Krishnamoorthi R, Bomman S, Benias P et al (2022) Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis. Endosc Int Open 10:E874–E897
Issaka RB, Shapiro DM, Parikh ND et al (2014) Palliative venting percutaneous endoscopic gastrostomy tube is safe and effective in patients with malignant obstruction. Surg Endosc 28:1668–1673
Porter RJ, McKinlay AW, Metcalfe EL (2021) Endoscopically placed venting gastrostomy can be a safe and effective palliative intervention in benign and malignant gastrointestinal obstruction. Frontline Gastroenterol 13:309–315
van der Gaag NA, Rauws EAJ, van Eijck CHJ et al (2010) Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 362:129–137
Jang S, Stevens T, Parsi M et al (2018) Association of covered metallic stents with cholecystitis and stent migration in malignant biliary stricture. Gastrointest Endosc 87:1061–1070
Dumonceau JM, Tringali A, Papanikolaou IS et al (2018) Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline-updated October 2017. Endoscopy 2018(50):910–930
Rizzo GEM, Carrozza L, Quintini D et al (2023) A systematic review of endoscopic treatments for concomitant malignant biliary obstruction and malignant gastric outlet obstruction and the outstanding role of endoscopic ultrasound-guided therapies. Cancers 15:2585
Hayat U, Al Shabeeb R, Perez P et al (2023) Gastrointest Endosc
Beyer F, Rice S, Orozco-Leal G et al (2023) Clinical and cost effectiveness of endoscopic bipolar radiofrequency ablation for the treatment of malignant biliary obstruction: a systematic review. Health Technol Assess 27:1–118
Koulouris AI, Alexandre L, Hart AR et al (2021) Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) technique and analgesic efficacy in patients with pancreatic cancer: a systematic review and meta-analysis. Pancreatology 21:434–442
Yasuda I, Wang HP (2017) Endoscopic ultrasound-guided celiac plexus block and neurolysis. Dig Endosc 29:455–462
Levy MJ, Gleeson FC, Topazian MD et al (2019) Combined celiac ganglia and plexus neurolysis shortens survival, without benefit, vs plexus neurolysis alone. Clin Gastroenterol Hepatol 17:728–738
Veld J, Umans D, van Halsema E et al (2020) Self-expandable metal stent (SEMS) placement or emergency surgery as palliative treatment for obstructive colorectal cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol 155:103110
Ribeiro IB, Bernardo WM, Martins BDC et al (2018) Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis. Endosc Int Open 6:E558–67
Takahashi H, Okabayashi K, Tsuruta M et al (2015) Self-expanding metallic stents versus surgical intervention as palliative therapy for obstructive colorectal cancer: a meta-analysis. World J Surg 39:2037–2044
van Hooft JE, Veld JV, Arnold D (2020) Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020. Endoscopy 52:389–407
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
J. Wedemeyer gibt an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Additional information
Hinweis des Verlags
Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.
QR-Code scannen & Beitrag online lesen
Rights and permissions
About this article
Cite this article
Wedemeyer, J. Stellenwert interventioneller endoskopischer Verfahren. Onkologie (2024). https://doi.org/10.1007/s00761-024-01500-7
Accepted:
Published:
DOI: https://doi.org/10.1007/s00761-024-01500-7