Palliative Therapie maligner distaler Gallenwegsverschlüsse – endoskopisch versus offen

Die Inzidenz der malignen Erkrankungen, die zum Verschluss des distalen Gallengangs führen, steigt kontinuierlich. Die häufigste Ursache ist das Pankreaskarzinom. Die Mehrheit der Patienten mit distalem malignem Gallenwegsverschluss leiden zum Zeitpunkt der Diagnosestellung an einem nicht mehr kurativ resektablen Tumor, sodass palliative Konzepte im Vordergrund stehen. Hauptziel der effektiven Palliation ist der dauerhafte Erhalt der Lebensqualität. Dabei stehen verschiedene medikamentöse, zytostatische, endoskopische, chirurgische, radiotherapeutische und supportive Maßnahmen zur Verfügung. Eine zentrale Rolle spielt die frühzeitige Entlastung der Gallenwegsobstruktion und der begleitenden Duodenalstenose mittels endoskopischer Stentanlage oder chirurgischer Anlage von Bypassanastomosen zum Gallengang und Magen. Die genauen Indikationsgebiete der Endoskopie und der Chirurgie in der palliativen Behandlung des malignen distalen Gallenwegsverschlusses sind kontrovers und nicht endgültig definiert, sodass das Management dieser Patienten einen interdisziplinären Umgang an Kliniken mit hoher Expertise benötigt.

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