Zusammenfassung
Die Endosonografie gilt als die exakteste Methode beim Staging von Ösophagus- und
Magenkarzinomen. Die Endosonografie ermöglicht eine Differenzierung des T-Stadiums
beim Ösophagus- und Magenkarzinom mit einer Genauigkeit zwischen 65 und 90 %. Bei
der Einschätzung von Frühkarzinomen scheint die Minisondenendosonografie jedoch der
makroskopischen Beurteilung durch einen erfahrenen Endoskopiker nicht überlegen zu
sein. Ein weiteres, die Therapie entscheidendes Kriterium ist der Lymphknotenstatus.
Hier zeigt die Endosonografie eine hohe Sensitivität, jedoch eine nicht zufriedenstellende
Spezifität. Durch die Feinnadelpunktion suspekter Lymphknoten, die mit einer sehr
niedrigen Komplikationsrate einhergeht, kann mittels zytologischer Beurteilung eine
Steigerung der Spezifität erreicht werden. Aber auch neue Methoden, wie die kontrastmittelverstärkte
Endosonografie oder die Elastografie, scheinen bei der Differenzierung suspekter Lymphknoten
hilfreich zu sein.
Abstract
Endosonography is considered to be the most exact method for the staging of carcionomas
of the oesophagus and stomach. It enables a differentiation of the T stages of carcinomas
of the oesophagus and stomach with an accuracy of between 65 and 90 %. Endosonography
with a mini-probe, however, does not appear to be superior to the macroscopic evaluation
by an experienced endoscopist. A futher decisive criterion for therapy is the lymph
node status. Here, endosonography exhibits a high sensitivity albeit with an unsatisfactory
specificity. The specificity can be increased by the cytological evaluation of biopsy
samples from the fine needle puncture of suspicious lymph nodes, a method with a very
low complication rate. But new methods such as contrast medium-enhanced endosonography
or elastography also appear to be useful for the differentiation of suspicious lymph
nodes.
Schlüsselwörter
Magenkarzinom - Ösophaguskarzinom - Barrett-Ösophagus
Key words
stomach carcinomas - oesophageal carcinoma - Barrett’s oesophagus
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PD Dr. med. Oliver Pech
Oberarzt Innere Medizin 2, HSK Wiesbaden
Ludwig-Erhard-Str. 100
65199 Wiesbaden
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