Zusammenfassung
Die endoskopische Therapie von Magenfrühkarzinomen ist unter Beachtung einiger Voraussetzungen angemessen. Etabliert ist die Therapie von mukosalen Karzinomen. Besteht bereits eine Infiltration in die Submukosa, muss die mögliche Lymphknotenmetastasierung beachtet werden. Sinnvoll ist die Lokaltherapie daher nur bei gut differenzierten Karzinomen kleiner als 3 cm mit einer Infiltrationstiefe von weniger als 500 µm in der Submukosa (sm1) und fehlender Beteiligung von Lymphgefäßen oder Venen. Durch Zusammenführung der Fälle in Zentren lässt sich die Sicherheit in der Durchführung der ESD gewährleisten. Die lokale Therapie geht mit einem potenziell geringerem Morbiditäts- und Mortalitätsrisiko einher als eine Gastrektomie und resultiert darüber hinaus in einer besseren Lebensqualität.
Abstract
Endoscopic treatment is appropriate for selected cases of early gastric neoplasia. Standard therapy is the local resection of mucosal cancer. If the submucosal layer is infiltrated, the possibility of lymph node metastasis must be considered. Lesions with size less than 3 cm, well differentiated type histology, less than 500 µm submucosal penetration classified as sm1 and absence of lymphatic-vascular involvement are indicated factors for ESD. Safety of ESD is provided in centers of high endoscopic skills. The local treatment potentially lowers the risk of morbidity and mortality compared to the gastrectomy and results in a better quality of life.
Schlüsselwörter
Magenfrühkarzinom - endoskopische Therapie - endoskopische Submukosadissektion
Key words
early gastric neoplasia - endoscopic therapy - endoscopic submucosal dissection
Literatur
-
1
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
-
2
Abe N, Sugiyama M, Masaki T et al.
Predictive factors for lymph node metastasis of differentiated submucosally invasive gastric cancer.
Gastrointestinal Endoscopy.
2004;
60
242-245
-
3
Hyung W J, Noh S H, Lee J H et al.
Early gastric carcinoma with signet ring cell histology.
Cancer.
2002;
94
78-83
-
4
Soetikno R, Kaltenbach T, Yeh R et al.
Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. Review.
Journal of Clinical Oncology.
2005;
23
4490-4498
-
5
Tanaka M, Ono H, Hasuike N et al.
Endoscopic submucosal dissection of early gastric cancer. Review.
Digestion.
2008;
77 Suppl 1
23-28
-
6
Gotoda T.
Endoscopic resection of early gastric cancer.
Gastric Cancer.
2007;
10
1-11
-
7
Oda I, Saito D, Tada M et al.
A multicenter retrospective study of endoscopic resection for early gastric cancer.
Gastric Cancer.
2006;
9
262-270
-
8
Takenaka R, Kawahara Y, Okada H et al.
Risk factors associated with local recurrence of early gastric cancers after endoscopic submucosal dissection.
Gastrointest Endosc.
2008;
68
887-894
-
9
Yamaguchi N, Isomoto H, Fukuda E et al.
Clinical outcomes of endoscopic submucosal dissection for early gastric cancer by indication criteria.
Digestion.
2009;
80
173-181
-
10
Nakajima T, Oda I, Gotoda T et al.
Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?.
Gastric Cancer.
2006;
9
67-69
-
11
Rösch T, Sarbia M, Schumacher B et al.
Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series.
Endoscopy.
2004;
36
788-801
-
12
Neuhaus H, Wirths K, Enderle M et al.
Randomized controlled study of endoscopic mucosal resection (emr) versus endoscopic submucosal dissection with a waterjet hybridknife (esdh) of esophageal lesions in a porcine model.
Gastrointestinal Endoscopy.
2008;
67
AB 90-AB 90 H
-
13
Neuhaus H, Costamagna G, Deviere J ARCADE Group et al.,.
Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”).
Endoscopy.
2006;
38
1016-1023
-
14
Chung I K, Lee J H, Lee S H et al.
Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study.
Gastrointest Endosc.
2009;
69
1228-1234
-
15
Goto O, Fujishiro M, Kodashima S et al.
Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria.
Endoscopy.
2009;
41
118-122
-
16
Nozaki I, Kubo Y, Tanada M et al.
Long-term outcome after laparoscopic wedge resection for early gastric cancer.
Surg Endosc.
2008;
22
2665-2669
-
17
Nakamoto S, Sakai Y, Kasanuki J et al.
Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan: a comparative study with endoscopic submucosal dissection.
Endoscopy.
2009;
41
746-750
-
18
Jang J S, Choi S R, Qureshi W et al.
Long-term outcomes of endoscopic submucosal dissection in gastric neoplastic lesions at a single institution in South Korea.
Scand J Gastroenterol.
2009;
44
1315-1322
T. Nordmann
Medizinische Klinik · Ev. Krankenhaus Düsseldorf
Kirchfeldstr. 40
40217 Düsseldorf
Telefon: 02 11 / 9 19 16 05
Fax: 02 11 / 9 19 39 60
eMail: thomas.nordmann@evk-duesseldorf.de
