Zusammenfassung
Die endoskopische Therapie hat sich beim Magenfrühkarzinom als effektiv und sicher erwiesen. Sie ist minimal-invasiv, organerhaltend und eine sichere Alternative zur chirurgischen Resektion. Voraussetzung für die kurativ intendierte endoskopische Therapie ist, dass keine Risikofaktoren für eine Lymphknotenmetastasierung vorliegen.
In Analogie zu chirurgischen Hochvolumenzentren sollte die endoskopische Therapie in Zentren mit hoher Expertise in den Techniken der endoskopischen Resektion (ER), der Suck-and-Cut-ER und der endoskopischen Submukosadissektion (ESD), erfolgen. Aufgrund des Risikos neoplastischer Zweitläsionen ist ein standardisiertes Nachsorgeprotokoll nach endoskopischer Therapie erforderlich. In der Regel ist eine kurative endoskopische Therapie auch dieser Zweitläsionen möglich.
Im vorliegenden Artikel werden Diagnostik, Techniken, Indikationsstellung und Nachbeobachtungsstrategie bei der endoskopischen Therapie von Magenfrühkarzinomen dargestellt.
Abstract
Endoscopic treatment of early gastric cancer has been shown to be effective and safe. It is a minimally invasive and organ-preserving treatment approach that can safely be used as an alternative to surgical resection. A prerequisite of any endoscopic treatment with a curative intent is a very low risk of lymph node metastasis of the lesion intended to be endoscopically resected.
As in high-volume surgical centers all endoscopic procedures with a curative intent should also be carried out in centers with a high expertise in the different endoscopic resection (ER) techniques available, the major techniques being suck-and-cut ER and endoscopic submucosal dissection (ESD). Because of the risk of secondary neoplasia after curative endoscopic therapy, a standardized follow-up protocol is required. The majority of secondary neoplastic lesions can again be treated endoscopically.
In the present article an overview of initial staging procedures, techniques, indications, as well as follow-up strategies after endoscopic therapy for early gastric cancer is given.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Honorare für Dozententätigkeiten bei ER&ESD-Work-Shop van Fa. Fujinon, Fujifilm, Willich, DTL.
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Manner, H., Pech, O. & Ell, C. Endoskopische Therapie von Magenfrühkarzinomen. Chirurg 83, 9–15 (2012). https://doi.org/10.1007/s00104-011-2147-z
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DOI: https://doi.org/10.1007/s00104-011-2147-z
Schlüsselwörter
- Magenkarzinom
- Endoskopische Therapie
- Endoskopische Resektion
- Endoskopische Submukosadissektion
- Lymphknotenmetastasen