Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei prämalignen und malignen gastrointestinalen Neoplasien

Zusammenfassung

Einleitung: Die endoskopische Submukosa-Dissektion (ESD) früher gastrointestinaler Neoplasien findet weltweit zunehmende Akzeptanz. In Deutschland ist die ESD auf größere Zentren begrenzt und die Datenlage spärlich. Ziel der vorliegenden Studie ist die Darstellung der Ergebnisse von 46 ESDs eines deutschen Endoskopiezentrums.

Material und Methodik: Zwischen Juni 2007 und Mai 2012 wurden 46 ESDs bei 45 Patienten (33 Männer, 12 Frauen, mittleres Alter: 66,1 Jahre) im Ösophagus (n = 17), Magen (n = 23) und Rektum (n = 6) durchgeführt. Es wurde die technische Erfolgsrate, die Rate der En-bloc-, der R0- und der R0-en-bloc-Resektionen, die Komplikationsrate, die Rate kurativer endoskopischer ESDs sowie die lokale Rezidivrate im Follow-up ermittelt. Die Daten wurden zur Beurteilung eines Lernerfolgs innerhalb zweier Zeitintervalle (Juni 2007 bis Nov. 2010 and Dez. 2010 bis Mai 2012) ausgewertet.

Ergebnisse: Die technische Erfolgsrate der ESD lag bei 93,5 %. Die En-bloc-R0-, R0-en-bloc- und die kurative Resektionsrate lag bei 90,7 %, 74,4 %, 67,4 % bzw. 65,1 %. Die Komplikationsrate lag bei 13 %. Im Verlauf konnte die Rate der En-bloc- und der R0-en-bloc-Resektionen von 81 % auf 100 % bzw. von 52,4 % auf 81,8 % gesteigert werden. Die overall Lokalrezidivrate im Follow-up (median 11,4 Monate) betrug 10 %. Nach einer kurativen R0-en-bloc-Resektion von Malignomen traten keine Lokalrezidive auf.

Diskussion: Die vorliegenden Daten unterstreichen trotz der kleinen Fallzahl die Wertigkeit der ESD, insbesondere bei R0-en-bloc-Resektionen in der Therapie prämaligner und früher maligner gastrointestinaler Neoplasien. Aufgrund der notwendigen Lernkurve sollte die Durchführung einer ESD in Deutschland größeren endoskopischen Zentren vorbehalten bleiben.

Abstract

Introduction: Worldwide endoscopic submucosal dissection (ESD) of early GI cancers or premalignant neoplasia is becoming increasingly important. In Germany ESD is restricted to larger endoscopic institutions and only a few literature reports are available. The aim of the present study is to describe the results of 46 ESDs conducted in a German endoscopic centre.

Material and Methods: Between June 2007 and May 2012 46 ESDs in 45 patients (33 men, 12 women, mean age 66.1 years) were performed in the oesophagus (n = 17), stomach (n = 23) and rectum (n = 6). Data were collected for the en-bloc, R0 and R0 en-bloc resection rates as well as for complications, the curative resection and the local recurrence rates. In order to demonstrate a learning curve, results were evaluated for two periods (June 2007 to November 2010 vs. December 2010 to May 2012).

Results: ESD was technically possible in 93.5 %. En-bloc, R0, R0 en-bloc and curative resection rates were 90.7 %, 74.4 %, 67.4 % and 65.1 %, respectively. The complication rate was 13 %. In the second period en-bloc and R0 en-bloc resection rates increased from 81 % to 100 % and, respectively, from 52.4 % to 81.8 %. After a medium follow-up of 11.4 months, local tumour recurrence occurred in 10 %. In cases of curative R0 en bloc resection of malignant tumours no tumour recurrence occurred.

Discussion: Despite the small number of patients, the present data underline the value of ESD, especially in cases of R0 en-bloc resections in the therapy for premalignant and early malignant GI tumours. Due to the required learning curve, ESD should be restricted to larger endoscopic centres in Germany.

Schlüsselwörter

endoskopische Submukosa-Dissektion (ESD) - Frühkarzinom - endoskopische Tumorresektion

Key words

endoscopic submucosal dissection (ESD) - early cancer - endoscopic tumour resection

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