nach oben

Die Innere Medizin

Erschienen in:

05.07.2023 | Diagnostik in der Gastroenterologie | CME

Interventionelle Endoskopie in der Gastroenterologie

verfasst von: PD Dr. med. Marcus Hollenbach, Dr. med. Kien Vu Trung, Prof. Dr. med. Albrecht Hoffmeister

Erschienen in: Die Innere Medizin | Ausgabe 8/2023

zum CME-Kurs Einloggen, um Zugang zu erhalten

Zusammenfassung

Wesentliche Innovationen in der interventionellen Endoskopie haben das therapeutische Armamentarium in der Gastroenterologie deutlich erweitert. Therapie und Komplikationsmanagement bei intraepithelialen Neoplasien und Frühkarzinomen werden immer häufiger primär endoskopisch adressiert. Bei endoluminalen Läsionen ohne Risiko von Lymphknoten- oder Fernmetastasen haben sich die endoskopische Mukosaresektion und die endoskopische Submukosadissektion als Standard etabliert. Bei breitbasig wachsenden Adenomen sollte die Koagulation der Resektionsränder im Falle einer Piecemeal-Resektion angewendet werden. Submukosale Läsionen sind durch Tunnelungstechniken erreich- und resezierbar. Die perorale endoskopische Myotomie bei Achalasie stellt eine Option für hypertensive und hyperkontraktile Motilitätsstörungen dar. Auch bei Gastroparese gibt es vielversprechende Daten für diese Interventionstechnik. Im vorliegenden Beitrag werden neue Resektionstechniken sowie die sogenannte Third-space-Endoskopie dargestellt und kritisch diskutiert.

Axon ATR (2020) Fifty years of digestive endoscopy: Successes, setbacks, solutions and the future. Dig Endosc 32:290–297. https://doi.org/10.1111/den.13593CrossRefPubMed

Bohlman TW, Katon RM, Lipshutz GR et al (1977) Fiberoptic pansigmoidoscopy. An evaluation and comparison with rigid sigmoidoscopy. Gastroenterology 72:644–649CrossRefPubMed

DeWitt J, Van Dam J (2018) Development of endoscopy—gastroenterology diamond jubilee review. Gastroenterology 155:237–240. https://doi.org/10.1053/j.gastro.2018.04.002CrossRefPubMed

Trung VK, Hollenbach M, Hoffmeister A (2023) Endoscopic treatment for obesity and diabetes. Dtsch Med Wochenschr 148:102–111. https://doi.org/10.1055/a-1832-4057CrossRef

Hollenbach M, Feisthammel J, Hoffmeister A (2020) Interventional endoscopy in the gastrointestinal tract : Indications and limitations. Internist 61:1017–1030. https://doi.org/10.1007/s00108-020-00845-6CrossRefPubMed

Bemelman WA, Baron TH (2018) Endoscopic management of transmural defects, including leaks, perforations, and fistulae. Gastroenterology 154:1938–1946.e1. https://doi.org/10.1053/j.gastro.2018.01.067CrossRefPubMed

Dekker E, Rex DK (2018) Advances in CRC prevention: screening and surveillance. Gastroenterology 154:1970–1984. https://doi.org/10.1053/j.gastro.2018.01.069CrossRefPubMed

Ferlitsch M, Moss A, Hassan C et al (2017) Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 49:270–297. https://doi.org/10.1055/s-0043-102569CrossRefPubMed

Hollenbach M, Feisthammel J, Hoffmeister A (2021) Endoscopic diagnosis, treatment, and follow-up of polyps of the lower gastrointestinal tract. Internist 62:151–162. https://doi.org/10.1007/s00108-020-00902-0CrossRefPubMed

10.

Burgess NG, Hourigan LF, Zanati SA et al (2017) Risk stratification for covert invasive cancer among patients referred for colonic endoscopic mucosal resection: a large multicenter cohort. Gastroenterology 153:732–742.e1. https://doi.org/10.1053/j.gastro.2017.05.047CrossRefPubMed

11.

Gupta S, Miskovic D, Bhandari P et al (2011) The ‘SMSA’ scoring system for determining the complexity of a polyp. Gut 60:A129–A129. https://doi.org/10.1136/gut.2011.239301.273CrossRef

12.

van Hattem WA, Shahidi N, Vosko S et al (2021) Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods. Gut 70:1691–1697. https://doi.org/10.1136/gutjnl-2020-321753CrossRefPubMed

13.

Moss A, Bourke MJ, Williams SJ et al (2011) Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 140:1909–1918. https://doi.org/10.1053/j.gastro.2011.02.062CrossRefPubMed

14.

Klein A, Qi Z, Bahin FF et al (2018) Outcomes after endoscopic resection of large laterally spreading lesions of the papilla and conventional ampullary adenomas are equivalent. Endoscopy 50:972–983CrossRefPubMed

15.

Klein A, Tate DJ, Jayasekeran V et al (2019) Thermal ablation of mucosal defect margins reduces Adenoma recurrence after colonic endoscopic mucosal resection. Gastroenterology 156:604–613.e3. https://doi.org/10.1053/j.gastro.2018.10.003CrossRefPubMed

16.

Sidhu M, Shahidi N, Gupta S et al (2021) 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 161:163–170.e3. https://doi.org/10.1053/j.gastro.2021.03.044CrossRefPubMed

17.

Nagl S, Ebigbo A, Goelder SK et al (2021) Underwater vs conventional endoscopic mucosal resection of large sessile or flat colorectal polyps: a prospective randomized controlled trial. Gastroenterology 161:1460–1474.e1. https://doi.org/10.1053/j.gastro.2021.07.044CrossRefPubMed

18.

Tziatzios G, Gkolfakis P, Triantafyllou K et al (2021) Higher rate of en bloc resection with underwater than conventional endoscopic mucosal resection: a meta-analysis. Dig Liver Dis 53:958–964. https://doi.org/10.1016/j.dld.2021.05.001CrossRefPubMed

19.

Kaul V, Diehl D, Enslin S et al (2021) Safety and efficacy of a novel powered endoscopic debridement tissue resection device for management of difficult colon and foregut lesions: first multicenter U.S. experience. Gastrointest Endosc 93:640–646. https://doi.org/10.1016/j.gie.2020.06.068CrossRefPubMed

20.

Gotink AW, Peters Y, Bruno MJ et al (2022) Nonthermal resection device for ablation of Barrett’s esophagus: a feasibility and safety study. Endoscopy 54:545–552. https://doi.org/10.1055/a-1644-4326CrossRefPubMed

21.

Fuccio L, Hassan C, Ponchon T et al (2017) Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 86:74–86.e17. https://doi.org/10.1016/j.gie.2017.02.024CrossRefPubMed

22.

Chedgy FJQ, Bhattacharyya R, Kandiah K et al (2016) Knife-assisted snare resection: a novel technique for resection of scarred polyps in the colon. Endoscopy 48:277–280. https://doi.org/10.1055/s-0035-1569647CrossRefPubMed

23.

Su Y‑F, Cheng S‑W, Chang CC et al (2020) Efficacy and safety of traction-assisted endoscopic submucosal dissection: a meta-regression of randomized clinical trials. Endoscopy 52:338–348. https://doi.org/10.1055/a-1106-3761CrossRefPubMed

24.

Bordillon P, Pioche M, Wallenhorst T et al (2021) Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc 94:333–343. https://doi.org/10.1016/j.gie.2021.01.036CrossRefPubMed

25.

Tamaru Y, Kuwai T, Miyakawa A et al (2022) Efficacy of a traction device for endoscopic Submucosal dissection using a scissor-type knife: a randomized controlled trial. Am J Gastroenterol 117:1797–1804. https://doi.org/10.14309/ajg.0000000000002019CrossRefPubMed

26.

Pei Q, Qiao H, Zhang M et al (2021) Pocket-creation method versus conventional method of endoscopic submucosal dissection for superficial colorectal neoplasms: a meta-analysis. Gastrointest Endosc 93:1038–1046.e4. https://doi.org/10.1016/j.gie.2021.01.007CrossRefPubMed

27.

Libânio D, Pimentel-Nunes P, Bastiaansen B et al (2023) Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy. https://doi.org/10.1055/a-2031-0874CrossRefPubMed

28.

Terheggen G, Horn EM, Vieth M et al (2017) A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut 66:783–793. https://doi.org/10.1136/gutjnl-2015-310126CrossRefPubMed

29.

Facciorusso A, Antonino M, Di Maso M et al (2014) Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: a meta-analysis. World J Gastrointest Endosc 6:555–563. https://doi.org/10.4253/wjge.v6.i11.555CrossRefPubMedPubMedCentral

30.

Moehler M, Al-Batran S‑E, Andus T et al (2011) German S3-guideline „Diagnosis and treatment of esophagogastric cancer“. Z Gastroenterol 49:461–531. https://doi.org/10.1055/s-0031-1273201CrossRefPubMed

31.

Pérez-Cuadrado-Robles E, Quénéhervé L, Margos W et al (2018) Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors. Endosc Int Open 6:E1008–E1014. https://doi.org/10.1055/a-0577-7546CrossRefPubMedPubMedCentral

32.

Lian J, Wang G, Li S et al (2023) Endoscopic submucosal dissection for large duodenal laterally spreading lesions is feasible: a multi-center retrospective study. Surg Laparosc Endosc Percutan Tech 33:45–49. https://doi.org/10.1097/SLE.0000000000001136CrossRefPubMed

33.

McCarty TR, Aihara H (2021) Hybrid endoscopic submucosal dissection with novel helix tacking system for defect closure. J Am Soc Gastrointest Endosc 6:446–449. https://doi.org/10.1016/j.vgie.2021.06.001CrossRef

34.

Jacques J, Wallenhorst T, Chevaux J‑B et al (2022) Endoscopic Submucosal dissection (ESD) versus piece-meal endoscopic mucosal resection (EMR) for large laterally spreading lesions (LSL): French randomized controlled trial (RESECT-COLON). In: Endoscopy. Thieme, Stuttgart, S OP207

35.

Pimentel-Nunes P, Libânio D, Bastiaansen BAJ et al (2022) Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline—Update 2022. Endoscopy 54:591–622. https://doi.org/10.1055/a-1811-7025CrossRefPubMed

36.

Bomman S, Klair JS, Canakis A et al (2022) Safety and efficacy of endoscopic full thickness resection of upper gastrointestinal lesions using a full thickness resection device: a systematic review and meta-analysis. J Clin Gastroenterol. https://doi.org/10.1097/MCG.0000000000001803CrossRefPubMed

37.

Rd D, An B, Tr M et al (2022) Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2021.09.039CrossRef

38.

Zwager LW, Mueller J, Stritzke B et al (2022) Adverse events of endoscopic full-thickness resection: results from the German and Dutch nationwide colorectal FTRD registry. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2022.11.005CrossRefPubMed

39.

Zwager LW, Bastiaansen BAJ, van der Spek BW et al (2022) Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry. Endoscopy 54:475–485. https://doi.org/10.1055/a-1637-9051CrossRefPubMed

40.

van Rah E et al (2022) Relevance of polyp size for primary endoscopic full-thickness resection of suspected T1 colorectal cancers. Endoscopy. https://doi.org/10.1055/a-1790-5539CrossRef

41.

Brand M, Reimer S, Reibetanz J et al (2021) Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine tumors—a retrospective analysis. Int J Colorectal Dis 36:971–976. https://doi.org/10.1007/s00384-020-03800-xCrossRefPubMed

42.

Falt P, Zapletalová J, Urban O (2022) Endoscopic full-thickness resection versus endoscopic submucosal dissection in the treatment of colonic neoplastic lesions ≤ 30 mm—a single-center experience. Surg Endosc 36:2062–2069. https://doi.org/10.1007/s00464-021-08492-0CrossRefPubMed

43.

Gu L, Wu Y, Yi J et al (2023) Comparison of endoscopic full-thickness resection and ligation-assisted endoscopic full-thickness resection for small (≤ 1.5 cm) gastric subepithelial tumors originating from muscularis propria. Surg Endosc. https://doi.org/10.1007/s00464-023-09881-3CrossRefPubMedPubMedCentral

44.

Peng W, Tan S, Huang S et al (2019) Efficacy and safety of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors with more than 1‑year’ follow-up: a systematic review and meta-analysis. Scand J Gastroenterol 54:397–406. https://doi.org/10.1080/00365521.2019.1591500CrossRefPubMed

45.

Zhang Y, Wen J, Zhang S et al (2022) Clinical study of submucosal tunneling endoscopic resection and endoscopic submucosal dissection in the treatment of submucosal tumor originating from the muscularis propria layer of the esophagus. Medicine 101:e32380. https://doi.org/10.1097/MD.0000000000032380CrossRefPubMedPubMedCentral

46.

Kahaleh M, Bhagat V, Dellatore P et al (2022) Subepithelial tumors: how does endoscopic full-thickness resection & submucosal tunneling with endoscopic resection compare with laparoscopic endoscopic cooperative surgery? Endosc Int Open 10:E1491–E1496. https://doi.org/10.1055/a-1922-7890CrossRefPubMedPubMedCentral

47.

Pwy C, Hc Y, Sm C et al (2023) Endoscopic full-thickness resection (EFTR) compared to submucosal tunnel endoscopic resection (STER) for treatment of gastric gastrointestinal stromal tumors. Endosc Int Open. https://doi.org/10.1055/a-1972-3409CrossRef

48.

Du C, Chai N, Linghu E et al (2022) Clinical outcomes of endoscopic resection for the treatment of gastric gastrointestinal stromal tumors originating from the muscularis propria: a 7-year experience from a large tertiary center in China. Surg Endosc 36:1544–1553. https://doi.org/10.1007/s00464-021-08443-9CrossRefPubMed

49.

Familiari P, Borrelli de Andreis F, Landi R et al (2023) Long versus short peroral endoscopic myotomy for the treatment of achalasia: results of a non-inferiority randomised controlled trial. Gut. https://doi.org/10.1136/gutjnl-2021-325579CrossRefPubMed

50.

Khashab MA, Benias PC, Swanstrom LL (2018) Endoscopic myotomy for foregut motility disorders. Gastroenterology 154:1901–1910. https://doi.org/10.1053/j.gastro.2017.11.294CrossRefPubMed

51.

Inoue H, Minami H, Kobayashi Y et al (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271. https://doi.org/10.1055/s-0029-1244080CrossRefPubMed

52.

Teitelbaum EN, Dunst CM, Reavis KM et al (2018) Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders. Surg Endosc 32:421–427. https://doi.org/10.1007/s00464-017-5699-2CrossRefPubMed

53.

Akintoye E, Kumar N, Obaitan I et al (2016) Peroral endoscopic myotomy: a meta-analysis. Endoscopy 48:1059–1068. https://doi.org/10.1055/s-0042-114426CrossRefPubMed

54.

Werner YB, Hakanson B, Martinek J et al (2019) Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med 381:2219–2229. https://doi.org/10.1056/NEJMoa1905380CrossRefPubMed

55.

Nabi Z, Chavan R, Ramchandani M et al (2021) Long-term outcomes of per-oral endoscopic myotomy in spastic esophageal motility disorders: a large, single-center study. J Clin Gastroenterol 55:594–601. https://doi.org/10.1097/MCG.0000000000001395CrossRefPubMed

56.

Saleh CMG, Familiari P, Bastiaansen BAJ et al (2023) The efficacy of peroral endoscopic myotomy vs pneumatic dilation as treatment for patients with achalasia suffering from persistent or recurrent symptoms after Laparoscopic heller Myotomy: a randomized clinical trial. Gastroenterology. https://doi.org/10.1053/j.gastro.2023.02.048CrossRefPubMedPubMedCentral

57.

Kadiyala J, Canakis A, Lee DU et al (2023) Comparing clinical success and procedural difficulty between treatment-naïve and treatment-refractory patients with esophageal motility disorders during per oral endoscopic myotomy. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2023.01.052CrossRefPubMed

58.

Inoue H, Ueno A, Shimamura Y et al (2019) Peroral endoscopic myotomy and fundoplication: a novel NOTES procedure. Endoscopy 51:161–164. https://doi.org/10.1055/a-0820-2731CrossRefPubMed

59.

Shrigiriwar A, Zhang LY, Ghandour B et al (2023) Technical details and outcomes of peroral endoscopic myotomy with fundoplication: the first U.S. experience (with video). Gastrointest Endosc 97:585–593. https://doi.org/10.1016/j.gie.2022.10.027CrossRefPubMed

60.

Morley TJ, Mikulski MF, Rade M et al (2023) Per-oral endoscopic myotomy for the treatment of non-achalasia esophageal dysmotility disorders: experience from a single high-volume center. Surg Endosc 37:1013–1020. https://doi.org/10.1007/s00464-022-09596-xCrossRefPubMed

61.

Maselli R, Spadaccini M, Cappello A et al (2021) Flexible endoscopic treatment for Zenker’s diverticulum: from the lumen to the third space. Ann Gastroenterol 34:149–154. https://doi.org/10.20524/aog.2021.0575CrossRefPubMedPubMedCentral

62.

Al Ghamdi SS, Farha J, Moran RA et al (2022) Zenker’s peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker’s diverticulum: a multicenter retrospective comparison. Endoscopy 54:345–351. https://doi.org/10.1055/a-1518-7223CrossRefPubMed

63.

Ingrosso MR, Camilleri M, Tack J et al (2023) Efficacy and safety of drugs for gastroparesis: systematic review and network meta-analysis. Gastroenterology 164:642–654. https://doi.org/10.1053/j.gastro.2022.12.014CrossRefPubMed

64.

Khashab MA, Ngamruengphong S, Carr-Locke D et al (2017) Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video). Gastrointest Endosc 85:123–128. https://doi.org/10.1016/j.gie.2016.06.048CrossRefPubMed

65.

Shen S, Luo H, Vachaparambil C et al (2020) Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes. Endoscopy 52:349–358. https://doi.org/10.1055/a-1111-8566CrossRefPubMed

66.

Gourcerol G, Gonzalez JM, Bonaz B et al (2023) Gastric electrical stimulation versus per-oral pyloromyotomy for the treatment of nausea and vomiting associated with gastroparesis: An observational study of two cohorts. Neurogastroenterol Motil. https://doi.org/10.1111/nmo.14565CrossRefPubMedPubMedCentral

67.

Ichkhanian Y, Al-Haddad MA, Jacobs CC et al (2023) Gastric peroral endoscopic myotomy for management of refractory gastroparesis in patients with gastric neurostimulator devices: a multicenter retrospective case control study. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2023.04.2079CrossRefPubMed

68.

Aziz M, Gangwani MK, Haghbin H et al (2023) Gastric peroral endoscopic myotomy versus surgical pyloromyotomy/pyloroplasty for refractory gastroparesis: systematic review and meta-analysis. Endosc Int Open 11:E322–E329. https://doi.org/10.1055/a-1980-9942CrossRefPubMedPubMedCentral

69.

Martinek J, Hustak R, Mares J et al (2022) Endoscopic pyloromyotomy for the treatment of severe and refractory gastroparesis: a pilot, randomised, sham-controlled trial. Gut 71:2170–2178. https://doi.org/10.1136/gutjnl-2022-326904CrossRefPubMed

70.

Khashab MA, Wang AY, Cai Q (2023) AGA clinical practice update on gastric peroral endoscopic myotomy for gastroparesis: commentary. Gastroenterology. https://doi.org/10.1053/j.gastro.2023.02.027CrossRefPubMed

Titel: Interventionelle Endoskopie in der Gastroenterologie
verfasst von: PD Dr. med. Marcus Hollenbach
Dr. med. Kien Vu Trung
Prof. Dr. med. Albrecht Hoffmeister
Publikationsdatum: 05.07.2023
Verlag: Springer Medizin
Schlagwörter: Diagnostik in der Gastroenterologie
Endoskopie des Bauches und der Verdauungsorgane
Adenokarzinom des ösophagogastralen Übergangs
Magenkarzinom
Duodenalulkusperforation
Ösophagusvarizen
Motilitätsstörungen
Motilitätsstörungen
Dysphagie
Achalasie
Gastrointestinale Erkrankungen in der Hausarztpraxis
Endoskopie
Erschienen in: Die Innere Medizin / Ausgabe 8/2023
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI: https://doi.org/10.1007/s00108-023-01565-3

Magen-Darm-Erkrankungen in der Hausarztpraxis

Häufige gastrointestinale Krankheiten in der niedergelassenen Praxis sind Thema in diesem aufgezeichneten MMW-Webinar. Welche Differenzialdiagnosen bei Oberbauchbeschwerden sollten Sie kennen? Wie gelingt eine erfolgreiche probiotische Behandlung bei Reizdarm? Welche neuen Entwicklungen und praktischen Aspekte gibt es bei Diagnostik und Behandlung der chronisch entzündlichen Darmerkrankungen?

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2023

Wie behandeln? MDA5-positive Dermatomyositis mit Lungenbeteiligung

Weiterbildungsmonitor 2023

Unklare Lymphadenopathie entpuppt sich als VEXAS-Syndrom

Genderspezifische Diagnostik und Therapie in der Inneren Medizin

Sex matters - auch bei Schilddrüsenerkrankungen?

Fortbildungen und Kongresse des BDI

Magen-Darm-Erkrankungen in der Hausarztpraxis