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Maligne Obstruktion im Gastrointestinaltrakt

Möglichkeiten der endoskopischen Therapie

Malignant gastrointestinal obstructions

Possibilities of endoscopic procedures

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Der Gastroenterologe Aims and scope

Zusammenfassung

Ein Großteil der Patienten mit gastrointestinalen Tumoren entwickelt im Verlauf der Erkrankung tumorbedingte Obstruktionen, die entscheidend für die Prognose und Lebensqualität sind. Während die chirurgische Therapie in der kurativen Situation in Abhängigkeit vom Stadium der Erkrankung eine wesentliche Säule des therapeutischen Gesamtkonzeptes darstellt, wird sie in der Palliation durch endoskopische Therapieverfahren zunehmend in den Hintergrund gedrängt. Ursächlich hierfür sind die mit der Chirurgie vergleichbare hohe klinische Effektivität der Endoskopie, die im Vergleich geringen Komplikationen und die niedrigen Therapiekosten. Bei okkludierenden Tumoren des Ösophagus ist in der Palliation die Stenttherapie etabliert, chirurgische Therapieoptionen bleiben nur Ausnahmesituationen vorbehalten. Die Obstruktion des Magenausgangs kann endoskopisch und chirurgisch mit gleicher Effektivität behandelt werden. Die Therapie der Gallengangsobstruktion ist die Domäne der Endoskopie. Die Möglichkeiten der Therapie mit Kunststoffprothesen und Metallstents sind gut dokumentiert. Im Bereich des Kolons bedarf die interventionelle Therapie einer differenzierten Vorgehensweise unter Berücksichtigung der multimodalen Therapiemöglichkeiten und der patientenbezogenen Risiken.

Abstract

Patients with gastrointestinal malignancies very often develop malignant obstructions in the course of the underlying disease. In palliation, obstruction is one of the main factors influencing the prognosis and quality of life. Surgery is the main therapy option in curative treatment of patients while surgical therapy is now being replaced by endoscopic procedures in palliative situations due to equal effectiveness of both regimes, the low rate of complications and a shorter hospital stay. In malignant obstructive esophageal disease therapy with expansive metal stents is an established and well-documented procedure and surgery is only applied in exceptional cases. In cases of a malignant gastric outlet obstruction surgery and endoscopic therapy have the same effectiveness. The palliative therapy of malignant bile duct obstructions is routinely carried out by endoscopy. Placement of plastic stents and metal stents in the bile duct are well-documented endoscopic therapy options. In malignant colorectal obstructions a differentiated endoscopic intervention is recommended considering the modern multimodal therapy strategies and patients individual risks.

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Interessenkonflikt

Referententätigkeit von S. Aymaz und A.J. Dormann auf Veranstaltungen, die von den Firmen Boston Scientific und Cook gesponsert wurden.

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Authors and Affiliations

  1. Medizinische Klinik Holweide, Kliniken der Stadt Köln gGmbH, Neufelderstr. 34, 51067, Köln, Deutschland

    S. Aymaz M.Sc., U. Huegle, D. Mueller-Gerbes & A.J. Dormann

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  1. S. Aymaz M.Sc.
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  2. U. Huegle
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  3. D. Mueller-Gerbes
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  4. A.J. Dormann
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Correspondence to S. Aymaz M.Sc..

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Aymaz, S., Huegle, U., Mueller-Gerbes, D. et al. Maligne Obstruktion im Gastrointestinaltrakt. Gastroenterologe 6, 387–393 (2011). https://doi.org/10.1007/s11377-011-0541-1

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