Wann ist eine endoskopische Resektion einer Neoplasie im Ösophagus und der Kardia indiziert?

 

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Zusammenfassung

Die Sicherheit und Effektivität der endoskopischen Therapie von frühen Neoplasien im Barrett-Ösophagus und im Plattenepithel des Ösophagus in definierten Grenzen ist gut belegt und macht sie zur Therapie der ersten Wahl. Sie gewährleistet bei einer niedrigen Morbiditätsrate dem Patienten eine gute Lebensqualität und einen Organerhalt. Das Mortalitätrisiko ist minimal. Entscheidend für den Erfolg ist die frühe Diagnosestellung. Die Ösophagusresektion bzw. Radio-/Chemotherapie sind heute in der Therapie von ösophagealen Frühkarzinomen Reserveverfahren, die nur bei Patienten zum Einsatz kommen sollten, bei denen der Tumor definierte histologische Risikofaktoren aufweist oder die endoskopische Therapie versagt. Aktuell wird eine Ausweitung der Indikationskriterien für die endoskopische Therapie von Barrett-Adenofrühkarzinomen diskutiert, die eine oberflächliche Submukosainfiltration zeigen und keine weiteren histologischen Risikofaktoren aufweisen.

Abstract

There is good evidence for the safety and efficacy of endoscopic treatment for early neoplasia in Barrettʼs oesophagus and in oesophageal squamous epithelium within defined margins, and this form of therapy is therefore the treatment of choice. With a low morbidity rate, it offers patients a good quality of life with preservation of the organ. The mortality risk is minimal. The decisive element for success is early diagnosis. Oesophageal resection and radiotherapy/chemotherapy are nowadays reserve procedures in the treatment of early oesophageal carcinoma and should only be used in patients in whom the tumour shows defined histological risk factors or endoscopic therapy has failed. Discussion is currently taking place on whether the criteria used to indicate endoscopic therapy for early Barrettʼs adenocarcinoma can be expanded to include lesions with superficial submucosal infiltration and no additional histological risk factors.

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