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Palliative Stenttherapie im oberen und unteren Gastrointestinaltrakt

Wann sinnvoll und wann riskant?

Palliative stent therapy in the upper and lower gastrointestinal tract

When useful and when risky?

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Der Gastroenterologe Aims and scope

Zusammenfassung

Obstruktionen des Gastrointestinaltrakts sind Komplikationen gastrointestinaler Tumoren, die zu Dysphagie, Übelkeit, Erbrechen, Schmerzen, Cholestase oder Gewichtsverlust führen und mit einer Einschränkung der Lebensqualität einhergehen. Biliäre Obstruktionen schränken zudem die Therapiefähigkeit der Patienten ein. Selbstexpandierende Metallstents (SEMS) können maligne Obstruktionen mit hoher Effizienz behandeln und sind einer chirurgischen Therapie in der palliativen Gesamtsituation oftmals nicht unterlegen. Vorteile sind kurze Hospitalisierungszeiten und schnelle Erholung der Patienten im Vergleich zur palliativen Operation. Die SEMS sind beschichtet (fcSEMS) oder unbeschichtet (ucSEMS) verfügbar. Vorteile von fcSEMS sind, dass sie Fisteln effizient abdichten, seltener vom Tumor überwuchert und wieder entfernt werden können. Ein Nachteil ist die höhere Dislokationsrate. Komplikationen, wie Stentokklusion und Blutung, sind selten und die therapieassoziierte Mortalität ist sehr gering. Eine palliative Stenttherapie ist bei unterschiedlichen anatomischen Lokalisationen eine sinnvolle therapieergänzende Maßnahme bei Patienten mit Tumorleiden in der Palliativsituation.

Abstract

Gastrointestinal tumors can lead to obstruction of the gastrointestinal tract. Luminal obstructions lead to dysphagia, nausea, vomiting, pain, jaundice, and weight loss and are associated with a reduction in quality of life. They also limit the patient’s ability to receive systemic anticancer therapy, especially in biliary obstruction. Self-expanding metal stents (SEMS) treat malignant obstructions with high efficiency and are often not inferior to surgical treatment in the palliative setting. The advantages are short hospitalization times and rapid patient recovery compared to palliative surgery. Fully covered (fcSEMS) or uncovered metal stents (ucSEMS) are available. fcSEMS seal off fistulas more efficiently, are less likely to be overgrown or ingrown and can be removed. However, dislocation is more frequent compared to uncovered stents. Overall, complications like stent occlusion and bleeding are rare, and treatment-associated mortality is very low. Therefore, palliative stent therapy is an essential part of multidisciplinary therapy of patients with advanced cancer.

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Authors and Affiliations

  1. Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland

    Sophie Schlosser,  Arne Kandulski &  Martina Müller-Schilling

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  1. Sophie Schlosser
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Correspondence to Sophie Schlosser.

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S. Schlosser, A. Kandulski und M. Müller-Schilling geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Andrea Riphaus, Frankfurt

Ali Canbay, Bochum

Alexander Dechêne, Nürnberg

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Schlosser, S., Kandulski, A. & Müller-Schilling, M. Palliative Stenttherapie im oberen und unteren Gastrointestinaltrakt. Gastroenterologe 17, 174–178 (2022). https://doi.org/10.1007/s11377-022-00605-y

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