Endoskopie heute 2015; 28(02): 132-138
DOI: 10.1055/s-0035-1553913
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Single-Center-Erfahrung mit der Endoskopischen Submukosa-Dissektion (ESD) bei Barrett-Frühkarzinomen

Single-Center-Experience with endoscopic submucosal dissection (ESD) with early Barrett’s carcinoma
S. Höbel
1   Asklepios Klinik Barmbek, Gastroenterolgie & Interventionelle Endoskopie, Hamburg, Germany
,
R. Baumbach
1   Asklepios Klinik Barmbek, Gastroenterolgie & Interventionelle Endoskopie, Hamburg, Germany
,
P. Dautel
1   Asklepios Klinik Barmbek, Gastroenterolgie & Interventionelle Endoskopie, Hamburg, Germany
,
K. J. Oldhafer
2   Asklepios Klinik Barmbek, Viszeralchirurgie, Hamburg, Germany
,
A. Stang
3   Asklepios Klinik Barmbek, Onkologie & Palliativmedizin, Hamburg, Germany
,
B. Feyerabend
4   MVZ Hanse Histologikum GmbH, Hamburg, Germany
,
N. Yahagi
5   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
S. Faiss
1   Asklepios Klinik Barmbek, Gastroenterolgie & Interventionelle Endoskopie, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
07 December 2015 (online)

Zusammenfassung

Einleitung: Derzeit stellen die endoskopische Mukosaresektion (EMR) bzw. die operative Therapie die Standardtherapieverfahren des Barrett-Frühkarzinoms dar. Ein neues endoskopisches Resektionsverfahren ist die endoskopische Submukosa-Dissektion (ESD). Diese wurde in Japan entwickelt und gewinnt weltweit zunehmend an Bedeutung. Die ESD ermöglicht im Gegensatz zur EMR eine En-bloc-Resektion von Läsionen größer 2 cm und eine komplette histologische Aufarbeitung des resezierten Präparates inklusive der Beurteilung der Resektionsränder. Die Erfahrungen mit der ESD bei Barrett-Frühkarzinomen sind in Deutschland noch sehr begrenzt. Ziel der vorliegenden Studie ist die Darstellung der Ergebnisse von 34 ESDs bei Vorliegen eines Barrett-Frühkarzinoms eines deutschen Endoskopiezentrums.

Material und Methodik: Zwischen November 2009 und August 2015 wurden 34 ESDs (30 Männer, 4 Frauen, mittleres Alter: 63,52 Jahre) bei Patenten mit einem Barrett-Frühkarzinom 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.

Ergebnisse: Die technische Erfolgsrate der ESD lag bei 100 %. Die postinterventionellen histologischen Ergebnisse ergaben 24 gut differenzierte und 6 mäßig differenzierte mukosale Barrett-Frühkarzinome sowie 4 Submukosakarzinome, davon 2 gut differenzierte und 2 mäßig differenzierte Barrett-Frühkarzinome. Die En-bloc-, R0-, R0 En-bloc- und die kurative Resektionsrate lag bei 97,1, 85,3, 85,3 bzw. 76,5 %. Die Komplikationsrate lag bei 17,6 % (n = 2 Blutungen, n = 1 Perforationen, n = 3 Stenosen nach zirkumferenzieller Resektion). Nach kurativer R0 En-bloc-Resektion betrug die Lokalrezidivrate nach einem mittleren Follow-up von 1,68 Jahren 8 %.

Diskussion: Die vorliegenden Daten unterstreichen trotz der kleinen Fallzahl und des bislang kurzen Follow-up die Wertigkeit der ESD in der Therapie von Barrett-Frühkarzinomen, insbesondere bei R0 En-bloc-Resektionen. Langzeitergebnisse dieser neuen Methode müssen jedoch abgewartet werden. Insbesondere ist bei vielfach unterminierendem Wachstum von Barrett-Frühkarzinomen auf einen ausreichenden Sicherheitsabstand zu achten. Aufgrund des technisch anspruchsvollen Eingriffes sollte die ESD von Barrett-Frühkarzinomen großen Endoskopiezentren vorbehalten bleiben.

Abstract

Introduction: So far endoscopic mucosal resection (EMR) or radical surgical resection are the standard treatment options for patients with early Barrett’s adenocarcinoma. Endoscopic submucosal dissection (ESD) of neoplastic lesions of the gastrointestinal tract is a rather new endoscopic technique, which was developed in Japan and becomes increasing importance. The ESD allows in contrast to EMR an endoscopic en-bloc resection of lesions greater than 2 cm with a complete histological evaluation of the resected specimen. In Germany the experience with ESD in patients with early Barrett’s carcinoma is still limited. Therefore the aim of the present study is to describe the results of 34 ESDs in patients with early Barrett’s carcinoma performed in a German tertiary referral center.

Material and methods: Between November 2009 and August 2015 ESDs were performed in 34 patients (30 men, 4 women; mean age 63.52 years) with histologically proven Barrett’s adenocarcinoma. Data were given for the en-bloc, the R0, the R0 en-bloc and the curative resection rate as well as for the complication and the local recurrence rate after a follow-up period.

Results: ESD was technically possible in all of the 34 patients. Thirty of the resected neoplastic lesions showed an adenocarcinoma limited to the mucosa. Of these lesions, 24 were histopathologically defined as well-differentiated adenocarcinoma and 6 as moderately differentiated adenocarcinoma based on a Barrett’s mucosa. In contrast only 4 of the resected lesions showed an adenocarcinoma with submucosal invasion. 2 were histopathologically defined as well-differentiated adenocarcinoma and 2 as moderately differentiated adenocarcinoma. The en-bloc, R0, R0 en-bloc and curative resection rates were 97.1 %, 85.3 %, 85.3 % resp. 76.5 %. Complication rate was 17.6 % (perforation n = 1, delayed bleeding n = 2, esophageal stenosis n = 3). In case of curative tumor resection only 2 local tumor recurrence (8 %) occurred after a medium follow-up of 1.68 years.

Discussion: Despite the small number of patients and a relatively short follow-up, the present data underline the value of ESD especially in case of curative resections in the definite as well as less invasive therapy of early Barrett´s carcinoma. Special attention should be drawn towards subsquamous extension of Barrett´s adenocarcinoma requiring a sufficient safety margin as an obligate condition for tumor-free lateral resection margins. Due to the required learning curve and the management of potential complications ESD should be restricted to greater endoscopic centers.

 
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