Moderne endoskopische Resektionen im Kolorektum: Möglichkeiten, Perspektiven, Grenzen

Die meisten Polypen im unteren Gastrointestinaltrakt sind klein und technisch einfach zu resezieren. Doch auch ausgedehnte Polypen, frühe Karzinome oder subepitheliale Läsionen können heutzutage mit modernen Techniken sicher endoskopisch entfernt werden. Minimalinvasive endoskopische Resektionen ersetzen heute immer häufiger operative Eingriffe und bieten damit die Möglichkeit einer organerhaltenden Therapie. In diesem Beitrag werden die verschiedenen Techniken vorgestellt und deren Einsatzgebiete und Limitationen diskutiert.

Abstract

Since the first endoscopic polypectomies have been performed, the resection of premalignant lesions during colonoscopy has become a success story in the field of gastroenterology: Incidence and mortality of colorectal cancer have been significantly reduced with the implementation of screening programs. Most polyps in the lower gastrointestinal tract are small and easy to remove. However, larger polyps, early carcinomas and subepithelial lesions can be removed with modern endoscopic resection techniques as well. Minimally invasive endoscopic resections offer an organ-preserving alternative to surgery in a growing number of patients. In this review, we discuss the advantages and limitations of traditional and novel endoscopic resection techniques, including endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic full thickness resection.

Schlüsselwörter

Endoskopie - Polyp - Resektion - Kolorektum

Key words

endoscopy - polyp - resection technique - colorectum

Publication History

Article published online:
23 January 2023

• Literatur

• 1 Hewett DG, Kaltenbach T, Sano Y. et al. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology 2012; 143: 599-607 DOI: 10.1053/J.GASTRO.2012.05.006.
• 2 Hayashi N, Tanaka S, Hewett DG. et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013; 78: 625-632 DOI: 10.1016/J.GIE.2013.04.185.
• 3 Uraoka T, Saito Y, Matsuda T. et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 2006; 55: 1592 DOI: 10.1136/GUT.2005.087452.
• 4 Efthymiou M, Taylor AC, Desmond PV. et al. Biopsy forceps is inadequate for the resection of diminutive polyps. Endoscopy 2011; 43: 312-316 DOI: 10.1055/s-0030-1256086.
• 5 Park S, Ko BM, Han JP. et al. A prospective randomized comparative study of cold forceps polypectomy by using narrow-band imaging endoscopy versus cold snare polypectomy in patients with diminutive colorectal polyps. Gastrointest Endosc 2016; 83: 527-532.e1 DOI: 10.1016/j.gie.2015.08.053.
• 6 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297 DOI: 10.1055/s-0043-102569.
• 7 Huh CW, Kim JS, Choi HH. et al. Jumbo biopsy forceps versus cold snares for removing diminutive colorectal polyps: a prospective randomized controlled trial. Gastrointest Endosc 2019; 90: 105-111 DOI: 10.1016/j.gie.2019.01.016.
• 8 de Benito Sanz M, Hernández L, Garcia Martinez MI. et al. Efficacy and safety of cold versus hot snare polypectomy for small (5–9 mm) colorectal polyps: a multicenter randomized controlled trial. Endoscopy 2022; 54: 35-44
• 9 Mangira D, Cameron K, Simons K. et al. Cold snare piecemeal EMR of large sessile colonic polyps ≥ 20 mm (with video). Gastrointest Endosc 2020; 91: 1343-1352 DOI: 10.1016/J.GIE.2019.12.051.
• 10 Leitlinienprogramm Onkologie. S3-Leitlinie Kolorektales Karzinom. Langversion 2.1, 2019. Im Internet (Stand: 23.10.2022): https://www.leitlinienprogramm-onkologie.de/leitlinien/kolorektales-karzinom/
• 11 Moss A, Williams SJ, Hourigan LF. et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65 DOI: 10.1136/gutjnl-2013-305516.
• 12 van Hattem WA, Shahidi N, Vosko S. et al. Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods. Gut 2021; 70: 1691-1697 DOI: 10.1136/gutjnl-2020-321753.
• 13 Nagl S, Ebigbo A, Goelder SK. et al. Underwater vs Conventional Endoscopic Mucosal Resection of Large Sessile or Flat Colorectal Polyps: A Prospective Randomized Controlled Trial. Gastroenterology 2021; 161: 1460-1474.e1 DOI: 10.1053/j.gastro.2021.07.044.
• 14 Park SS, Han KS, Kim B. et al. Comparison of underwater endoscopic mucosal resection and endoscopic submucosal dissection of rectal neuroendocrine tumors (with videos). Gastrointest Endosc 2020; 91: 1164-1171.e2 DOI: 10.1016/J.GIE.2019.12.039.
• 15 Klein A, Tate DJ, Jayasekeran V. et al. Thermal Ablation of Mucosal Defect Margins Reduces Adenoma Recurrence After Colonic Endoscopic Mucosal Resection. Gastroenterology 2019; 156: 604-613.e3 DOI: 10.1053/j.gastro.2018.10.003.
• 16 Sidhu M, Shahidi N, Gupta S. et al. Outcomes of Thermal Ablation of the Mucosal Defect Margin After Endoscopic Mucosal Resection: A Prospective, International, Multicenter Trial of 1000 Large Nonpedunculated Colorectal Polyps. Gastroenterology 2021; 161: 163-170.e3 DOI: 10.1053/j.gastro.2021.03.044.
• 17 Bourke MJ, Neuhaus H, Bergman JJ. Endoscopic Submucosal Dissection: Indications and Application in Western Endoscopy Practice. Gastroenterology 2018; 154: 1887-1900.e5 DOI: 10.1053/J.GASTRO.2018.01.068.
• 18 Fleischmann C, Probst A, Ebigbo A. et al. Endoscopic Submucosal Dissection in Europe: Results of 1000 Neoplastic Lesions From the German Endoscopic Submucosal Dissection Registry. Gastroenterology 2021; 161: 1168-1178 DOI: 10.1053/j.gastro.2021.06.049.
• 19 Denzer U, Beilenhoff U, Eickhoff A. et al. S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021-022. Z Gastroenterol 2015; 53: E1-E227 DOI: 10.1055/s-0041-109598.
• 20 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854 DOI: 10.1055/S-0034-1392882.
• 21 Kuellmer A, Mueller J, Caca K. et al. Endoscopic full-thickness resection for early colorectal cancer. Gastrointest Endosc 2019; 89: 1180-1189.e1 DOI: 10.1016/j.gie.2018.12.025.
• 22 Wannhoff A, Meier B, Caca K. Systematic review and meta-analysis on effectiveness and safety of the full-thickness resection device (FTRD) in the colon. Z Gastroenterol 2022; 60: 741-752 DOI: 10.1055/a-1310-4320.
• 23 Dolan RD, Bazarbashi AN, McCarty TR. et al. Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis. Gastrointest Endosc 2022; 95: 216-224.e18 DOI: 10.1016/J.GIE.2021.09.039.
• 24 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289 DOI: 10.1136/GUTJNL-2016-313677.
• 25 Zwager LW, Bastiaansen BAJ, Bronzwaer MES. et al. Endoscopic full-thickness resection (eFTR) of colorectal lesions: results from the Dutch colorectal eFTR registry. Endoscopy 2020; 52: 1014-1023 DOI: 10.1055/A-1176-1107.
• 26 Meier B, Stritzke B, Kuellmer A. et al. Efficacy and Safety of Endoscopic Full-Thickness Resection in the Colorectum: Results From the German Colonic FTRD Registry. Am J Gastroenterol 2020; 115: 1998-2006 DOI: 10.14309/ajg.0000000000000795.
• 27 Schmidbaur S, Wannhoff A, Walter B. et al. Risk of appendicitis after endoscopic full-thickness resection of lesions involving the appendiceal orifice: a retrospective analysis. Endoscopy 2021; 53: 424-428 DOI: 10.1055/a-1227-4555.
• 28 Holmes I, Kim HG, Yang DH. et al. Avulsion is superior to argon plasma coagulation for treatment of visible residual neoplasia during EMR of colorectal polyps (with videos). Gastrointest Endosc 2016; 84: 822-829 DOI: 10.1016/j.gie.2016.03.1512.
• 29 Mahadev S, Vareedayah AA, Yuen S. et al. Outcomes of a hybrid technique using EMR and endoscopic full-thickness resection for polyps not amenable to standard techniques (with video). Gastrointest Endosc 2021; 94: 358-367.e1 DOI: 10.1016/j.gie.2021.02.009.