Z Gastroenterol 2005; 43(3): 295-303
DOI: 10.1055/s-2004-813546
Aktuelle Endoskopie

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Interventionelle Endoskopie bei benignen und malignen Gallengangsstenosen

Interventional Endoscopy for Benign and Malignant Bile Duct StricturesR. Jakobs1 , U. Weickert1 , D. Hartmann1 , J. F. Riemann1
  • 1Medizinische Klink C (Direktor: Prof. Dr. J. F. Riemann), Klinikum der Stadt Ludwigshafen gGmbH
Further Information

Publication History

Manuskript eingetroffen: 29.5.2004

Manuskript akzeptiert: 5.8.2004

Publication Date:
11 March 2005 (online)

Zusammenfassung

Die Entwicklung endoskopisch-interventioneller Verfahren hat in der Vergangenheit die Therapie von Gallengangsstenosen unterschiedlicher Ätiologie maßgeblich beeinflusst. Benigne Stenosen der Gallenwege entstehen vorwiegend nach operativen Eingriffen an der Gallenblase oder Leber bzw. bei entzündlichen Erkrankungen. Bei 60 - 90 % der Patienten führt die endoskopische Therapie mit Endoprothesen oder die Ballondilatation zu einem klinisch befriedigenden Ergebnis mit adäquater Aufweitung der Engstelle. Lediglich bei Strikturen infolge chronischer Pankreatitis ist es bisher nicht gelungen, durch die endoskopische Therapie langfristig die Lokalsituation zu bessern. Bei malignem Verschlussikterus ist die endoskopische Endoprotheseneinlage ein Grundpfeiler der Therapie und bessert nachweislich nicht nur den Ikterus, sondern auch die Lebensqualität. Mehrere Studien belegen die länger anhaltende Offenheit von Metallstents (SEMS) im Vergleich zu konventionellen Endoprothesen. Unter wirtschaftlichen Aspekten ist ein differenzierter Einsatz von SEMS notwendig, zumal viele Patienten mit malignem Verschlussikterus aufgrund der limitierten Lebenserwartung versterben, bevor die erste Plastikprothese okkludiert. Bei hilären Gallengangskarzinomen führt die Kombination aus photodynamischer Therapie und Endoprotheseneinlage wahrscheinlich zu einem Überlebensvorteil. Mit antiproliferativen Substanzen beschichtete oder bioresorbierbare Stents könnten in naher Zukunft zur Optimierung der endoskopischen Behandlungsergebnisse führen.

Abstract

During the past years several endoscopic and interventional techniques have been developed for the treatment of bile duct strictures and have had a strong impact on therapeutic regimens. Benign stenoses of the bile duct are mainly caused by cholecystectomy or liver resection or by inflammatory diseases. Insertion of an endoprosthesis insertion or balloon dilation is clinically successful in 60 to 90 % of these patients and will result in adequate opening of the stricture. To date, only bile duct stenosis in chronic pancreatitis are not improved satisfactorily by endoscopy. The insertion of an endoprosthesis is a cornerstone in the treatment of malignant obstructive jaundice in patients with cancer. Several comparative studies have demonstrated the advantages of self-expanding metal stents (SEMS) over plastic prostheses in terms of patency. A selective use of SEMS is mandatory, as the costs for SEMS are high and many patients with malignant jaundice will die with their first plastic prosthesis in situ without stent occlusion. In patients with hilar cholangiocarcinoma, the combination of photodynamic therapy and endoprosthesis insertion might result in a survival advantage. The use of bioabsorbable stent materials or coating of the stent with antiproliferative drugs will improve the treatment results in the future.

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Priv.-Doz. Dr. med. Ralf Jakobs

Med. Klinik C, Klinikum der Stadt Ludwigshafen

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