Zusammenfassung
Die Endosonografie gilt als die exakteste Methode beim Staging von Ösophagus- und Magenkarzinomen. Die Endosonografie ermöglicht eine Differenzierung des T-Stadiums beim Ösophagus- und Magenkarzinom mit einer Genauigkeit zwischen 65 und 90 %. Bei der Einschätzung von Frühkarzinomen scheint die Minisondenendosonografie jedoch der makroskopischen Beurteilung durch einen erfahrenen Endoskopiker nicht überlegen zu sein. Ein weiteres, die Therapie entscheidendes Kriterium ist der Lymphknotenstatus. Hier zeigt die Endosonografie eine hohe Sensitivität, jedoch eine nicht zufriedenstellende Spezifität. Durch die Feinnadelpunktion suspekter Lymphknoten, die mit einer sehr niedrigen Komplikationsrate einhergeht, kann mittels zytologischer Beurteilung eine Steigerung der Spezifität erreicht werden. Aber auch neue Methoden, wie die kontrastmittelverstärkte Endosonografie oder die Elastografie, scheinen bei der Differenzierung suspekter Lymphknoten hilfreich zu sein.
Abstract
Endosonography is considered to be the most exact method for the staging of carcionomas of the oesophagus and stomach. It enables a differentiation of the T stages of carcinomas of the oesophagus and stomach with an accuracy of between 65 and 90 %. Endosonography with a mini-probe, however, does not appear to be superior to the macroscopic evaluation by an experienced endoscopist. A futher decisive criterion for therapy is the lymph node status. Here, endosonography exhibits a high sensitivity albeit with an unsatisfactory specificity. The specificity can be increased by the cytological evaluation of biopsy samples from the fine needle puncture of suspicious lymph nodes, a method with a very low complication rate. But new methods such as contrast medium-enhanced endosonography or elastography also appear to be useful for the differentiation of suspicious lymph nodes.
Schlüsselwörter
Magenkarzinom - Ösophaguskarzinom - Barrett-Ösophagus
Key words
stomach carcinomas - oesophageal carcinoma - Barrett’s oesophagus
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PD Dr. med. Oliver Pech
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