Endoskopische Resektion von Frühtumoren im oberen Gastrointestinaltrakt – Diagnose und Therapie früher Neoplasien

Die endoskopische Mukosaresektion und – als ihre Erweiterung – die endoskopische Submukosadissektion haben sich in den letzten Jahren weltweit zunehmend in der Therapie gastrointestinaler Präkanzerosen und Frühkarzinome etabliert. Ist das Frühkarzinom des Barrett–/Ösophagus auf die Mukosa oder im Magen auf das obere Drittel der Submukosa begrenzt und finden sich keine mikrolymphangischen (L +/–) und mikrovenösen (V +/–) Tumorinfiltrationen, ist die endoskopische Resektion als Therapieverfahren der Wahl anzusehen. Sollte sich nach einer endoskopischen Resektion ein höheres Tumorstadium im Sinne einer tieferen Submukosainfiltration diagnostizieren lassen, besteht unverändert die Möglichkeit der chirurgischen Nachresektion, falls der Patient operabel ist.

Endoscopic resection of the mucosa – and its elaborationž endoscopic dissection of the submucosa – have become more and more established on a world–wide scale during the past few years in the treatment of gastro–intestinal precanceroses and early carcinomas. If the early carcinoma of Barrett's esophagus (Barrett's syndrome) is restricted to the mucosa or in the stomach to the upper third of the submucosa and if there are no microlymphangial (L +/–) and microvenous (V +/–) tumourous infiltrations, endoscopic resection must be considered to be the therapy of choice. In case a progressed stage of tumour is diagnosed after an endoscopic resection – the tumour signifying a deeper infiltration of the submucosa – there is always the possibility of subsequent surgical resection, provided the patient's condition permits surgery.

Key words

endoscopic resection of the mucosa - endoscopic resection of the submucosa - gastro–intestinal precanceroses - gastro–intestinal early carcinomas - Barrett's syndrome

Literatur

• 1 Tada M, Murata M, Murakami F. et al. . Development of the strip–off biopsy [in Japanese].  Gastroenterological Endoscopy. 1984;  26 833-839
• 2 Makuuchi H, Machimura T, Soh Y. et al. . Endoscopic mucosectomy for mucosal carcinomas in the esophagus.  Japanese Journal of Surgical Gastroenterology. 1991;  24 2599-2603
• 3 Inoue H, Endo M, Takeshita K. et al. . Endoscopic resection of carcinoma in situ of the esophagus accompanied by esophageal varices.  Surg Endosc. 1991;  5 182-184
• 4 Soehendra N, Binmoeller KF, Bohnacker S. et al. . Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer.  Endoscopy. 1997;  29 380-383
• 5 Hirao M, Masuda K, Asanuma T. et al. . Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline–epinephrine.  Gastrointest Endosc. 1988;  34 264-269
• 6 Makuuchi H.. Endoscopic mucosal resection for early esophageal cancer.  Dig Endosc. 1996;  8 175-179
• 7 Inoue H, Takeshita K, Hori H. et al. . Endoscopic mucosal resection with a cap–fitted panendoscope for esophagus, stomach, and colon mucosal lesions.  Gastrointest Endosc. 1993;  39 58-62
• 8 Ell C, May A, Gossner L. et al. . Endoscopic mucosal resection of early cancer and high–grade dysplasia in Barrett's esophagus.  Gastroenterology. 2000;  118 670-677
• 9 Tanabe S, Koizumi W, Kokutou M. et al. . Usefulness of endoscopic aspiration mucosectomy as compared with strip biopsy for the treatment of gastric mucosal cancer.  Gastrointestinal Endoscopy. 1999;  50 819-822
• 10 Watanabe K, Ogata S, Kawazoe S. et al. . Clinical outcome of EMR for gastric tumors: historical pilot evaluation between endoscope submucosal dissection and conventional mucosal resection.  Gastrointest Endosc. 2006;  63 776-782
• 11 Ell C, May A, Pech O. et al. . Curative endoscopic resection of early esophageal adenocarcinomas (Barrett's cancer).  Gastrointest Endosc. 2007;  65 3-10
• 12 May A, Gossner L, Pech O. et al. . Intraepithelial high–grade neoplasia and early adenocarcinoma in short–segment Barrett's esophagus (SSBE): curative treatment using local endoscopic treatment techniques.  Endoscopy. 2002;  34 604-610
• 13 May A, Gossner L, Pech O. et al. . Local endoscopic therapy for intraepithelial high–grade neoplasia and early adenocarcinoma in Barrett's oesophagus: acute–phase and intermediate results of a new treatment approach.  Eur J Gastroenterol Hepatol. 2002;  14 1085-1091
• 14 Behrens A, May A, Gossner L. et al. . Curative treatment for high–grade intraepithelial neoplasia in Barrett's esophagus.  Endoscopy. 2005;  37 999-1005
• 15 Bergmann JJ.. Endoscopic resection for treatment of mucosal Barrett's cancer: time to swing the pendulum.  Gastrointest Endosc. 2007;  65 11-13
• 16 Manner H, Pech O, May A. et al. .Endoscopic resection in „low–risk” submucosal Barrett's cancer. Gastroenterology 2008
• 17 Narahara H, Iishi H, Tatsuta M. et al. . Effectiveness of endoscopic mucosal resection with submucosal saline injection technique for superficial squamous carcinomas of the esophagus.  Gastrointest Endosc. 2000;  52 730-734
• 18 Pech O, Gossner L, May A. et al. . Endoscopic resection of superficial esophageal squamous cell carcinomas: Western Experience.  Am J Gastroenterol. 2004;  99 1226-1232
• 19 Pech O, May A, Gossner L. et al. . Curative endoscopic therapy in patients with early esophageal squamous–cell carcinoma or high–grade intraepithelial neoplasia.  Endoscopy. 2007;  39 30-35
• 20 Oyama T, Tomori A, Hotta K. et al. . Endoscopic submucosal dissection of early esophageal cancer.  Clin Gastroenterol Hepatol. 2005;  3
• 21 Kojima T, Parra–Blanco A, Takahashi H, Fujita R.. Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature.  Gastrointest Endosc. 1998;  48 550-554
• 22 Japanese Research Society for Gastric Cancer, Japanese classification of gastric carcinoma, Kanehara, Tokyo. 1999
• 23 Gotoda T, Yanagisawa A, Sasako M. et al. . Incidence of lymph node metastasis from early gastric cancer : estimation with a large number of cases at two large centers.  Gastric Cancer. 2000;  3 219-225
• 24 Miyamoto S, Muto M, Hamamoto Y. et al. . A new technique for endoscopic mucosal resection with an insulated–tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms.  Gastrointest Endosc. 2002;  55 576-581
• 25 Oka S, Tanaka S, Kaneko I. et al. . Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer.  Gastrointest Endosc. 2006;  64 877-883
• 26 Manner H, Rabenstein T, May A. et al. . Long–term results of endoscopic resection in early gastric cancer: the western experience.  Am J Gastroenterol. 2008;  103

Korrespondenz