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Primär sklerosierende Cholangitis

Surveillance und Malignität

Primary sclerosing cholangitis

Surveillance and malignancy

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Der Gastroenterologe Aims and scope

Zusammenfassung

Die primär sklerosierende Cholangitis (PSC) ist mit einem erhöhten Risiko gastrointestinaler Malignome assoziiert. Patienten mit PSC und Colitis ulcerosa haben ein noch höheres Risiko für die Entwicklung kolorektaler Karzinome als Patienten mit Colitis ulcerosa alleine. Die Überwachung mit jährlichen Kontrollkoloskopien mit Stufenbiopsieentnahme ist hier gut etabliert. Das erhöhte Risiko von cholangiozelluläen Karzinomen hingegen stellt eine komplexe Herausforderung für den behandelnden Gastroenterologen dar. Nur ein umfassendes Vorgehen mit Labordiagnostik, Bildgebung und komplexer umfangreicher endoskopischer Diagnostik erlaubt die rechtzeitige Diagnose von cholangiozellulären Karzinomen. Dies ist für die Prognose des Patienten und zur Bestimmung des Zeitpunkts einer Lebertransplantation, die die einzige kurative Therapie darstellt, von großer Relevanz. In dieser Übersichtsarbeit legen wir einen Schwerpunkt auf die mit der PSC assoziierten gastrointestinalen Malignome und diskutieren mögliche Überwachungsstrategien.

Abstract

Primary sclerosing cholangitis (PSC) is associated with an increased risk of gastrointestinal malignancies. Patients with PSC and ulcerative colitis have a higher risk of developing colorectal cancer than patients with ulcerative colitis alone. Surveillance employing annual screening colonoscopy is well established. However, the risk of cholangiocarcinoma remains a complex challenge for the gastroenterologist. Only comprehensive diagnostics including laboratory studies, imaging, and complex endoscopic diagnostics allow timely recognition of cholangiocarcinoma. This is most important for the prognosis of patients and relevant for determining the optimal time for liver transplantation, which remains the only curative treatment available so far. In this review, we focus on the gastrointestinal malignancies associated with PSC and discuss possible surveillance strategies.

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Interessenkonflikt

Der Autor Jochen Wedemeyer ist in der Vergangenheit als Referent für die Firma Falk tätig gewesen und hat Reisekostenerstattung der Firmen Boston Scientific, Olympus und Philips erhalten. Der Autor Tobias Weismüller hat in der Vergangenheit Reisekostenerstattung der Firmen Falk und GlaxoSmithKline erhalten.

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  1. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30655, Hannover, Deutschland

    T.J. Weismüller & J. Wedemeyer

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  1. T.J. Weismüller
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  2. J. Wedemeyer
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Correspondence to T.J. Weismüller.

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Weismüller, T., Wedemeyer, J. Primär sklerosierende Cholangitis. Gastroenterologe 4, 115–123 (2009). https://doi.org/10.1007/s11377-008-0259-x

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  • DOI: https://doi.org/10.1007/s11377-008-0259-x

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