Endoskopische Submukosadissektion bei Frühkarzinom des Magens

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

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