Endoskopische Therapie früher Neoplasien der Speiseröhre

Zusammenfassung

Bei der Therapie von Plattenepithel- und Barrettfrühkarzinomen konnte in den letzten Jahren der therapeutische Goldstandard, die radikale Ösophagusresektion, durch die endoskopische Therapie weitgehend abgelöst werden. Die Rationale der endoskopischen Therapie ist die Tatsache, dass hochgradige intraepitheliale Neoplasien und auf die Mukosa beschränkte Karzinome sehr selten lymphogen oder hämatogen metastasieren und aus diesem Grunde in der Regel eine Kuration mittels endoskopischer Abtragung der Neoplasie erreicht werden kann. Die Ösophagusresektion geht hingegen mit einer hohen Mortalität von 3-20 % und einer Morbidität von 40-50 % einher. Als lokalendoskopische Therapieverfahren konnten sich vor allem die photodynamische Therapie (PDT) und die endoskopische Resektion (ER) durchsetzen. Beide Verfahren zeigten in Studien hervorragende Ergebnisse bezüglich der Rate der kompletten Remission bei einer sehr niedrigen Komplikationsrate von ca. 3 %. Der entscheidende Vorteil der ER gegenüber der PDT ist die Möglichkeit, das Resektat bzw. den Tumor bezüglich der Infiltrationstiefe und der Tumorfreiheit der Resektionsränder (R0-Status) histologisch zu untersuchen.

Abstract

In recent years, radical oesophageal resection could have been replaced by endoscopic therapy in the treatment of early oesophageal cancer. The rationale behind endoscopic treatment of early oesophageal neoplasia is the fact that neoplasias limited to the mucosal layer have a very low risk for lymph node or distant metastasis and therefore local endoscopic removal of the neoplastic lesion is curative. In contrast, radical oesophageal resection is associated with a mortality rate of 3-20 % and a morbidity rate of 40-50 %. For endoscopic treatment, mainly photodynamic therapy (PDT) and endoscopic resection (ER) are used. Both methods have demonstrated excellent results regarding complete remission rates with a very low complication rate of about 3 %. The important advantage of ER in contrast to PDT is the fact that a histological specimen is obtained that can be evaluated by the pathologist regarding infiltration depth and status of the margins (R0-status).

Barrettösophagus - Ösophaguskarzinom - endoskopische Resektion - photodynamische Therapie

Barrett's oesophagus - oesophageal cancer - endoscopic resection - photodynamic therapy

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