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Endoskopische Therapie gastroduodenaler neuroendokriner Neoplasien

Endoscopic therapy for gastroduodenal neuroendocrine neoplasms

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Zusammenfassung

Neuroendokrine Neoplasien (NEN) stellen eine Gruppe potenziell maligner Tumoren dar, deren Manifestationsort in allen Abschnitten des Gastrointestinaltraktes, des Pankreas sowie des bronchopulmonalen Systems liegt. Im Vergleich mit anderen Subentitäten, wie z. B. pankreatischen oder jejunoilealen NEN, besitzen gastroduodenale NEN meist eine sehr günstige Prognose. Im Magen können 4 und im Duodenum 5 verschiedene Typen neuroendokriner Neoplasien unterschieden werden. Sie variieren wiederum in ihrem malignen Potenzial und damit auch in ihrem therapeutischen Ansatz. Endoskopische Verfahren haben bei dieser Entität aufgrund des einfachen Zuganges neben ihrer diagnostischen auch eine therapeutische Bedeutung. Neben der einfachen Abtragung kleiner Polypen (< 1 cm) mittels Zange oder Schlinge stehen mittlerweile auch invasivere Methoden („endoscopic mucosal resection“/„endoscopic submucosal dissection“) zur Verfügung, die sogar eine Abtragung von Läsionen bis 2 cm erlauben. Wichtige Kriterien im Rahmen der Risikoevaluation für eine alleinige endoskopische Therapie stellen bei gastralen NEN, neben der Größe der Läsion, der Ausschluss eines invasiven Wachstums mittels Endosonographie sowie die Tumorbiologie (NET-G1/G2 vs. NEC-G3) dar. Im Duodenum sollten nach Ausschluss o. g. Risikofaktoren dagegen ausschließlich Tumoren außerhalb der Ampulla vateri primär endoskopisch behandelt werden. Für periampulläre NEN stellt dagegen ein chirurgisches Vorgehen die Therapie der Wahl dar. Als individueller Ansatz ist in Einzelfällen auch ein kombiniert endoskopisch-laparoskopisches Resektionsverfahren denkbar. Im Rahmen der Nachsorge sind regelmäßige endoluminale Untersuchungen notwendig, da es insbesondere beim Typ-1-NEN des Magens häufig zu Rezidiven kommt.

Abstract

Neuroendocrine neoplasms (NEN) represent a group of potentially malignant tumors, which can be located in every section of the gastrointestinal tract, the pancreas and the bronchopulmonary system. Gastroduodenal NENs have a relatively good prognosis in comparison to other subentities, e.g. pancreatic or ileojejunal NENs. In the stomach there are four different types of NENs, while in the duodenum there are five types and all vary in the malignant potential and the therapeutic approach. Due to the simple access endoscopic methods not only have diagnostic but also important therapeutic relevance in this subgroup. Lesions smaller than 1 cm can easily be resected with forceps or snare resection and for larger lesions up to 2 cm more invasive strategies, such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are available. Important criteria in gastric NEN for the risk evaluation of endoscopic treatment alone are the size of the lesion, depth of invasion and the tumor biology, e.g. neuroendocrine tumor (NET) G1/G2 versus neuroendocrine carcinoma (NEC) G3. In duodenal NEN the aforementioned risk factors also apply and in addition only lesions outside the ampulla of Vater should be endoscopically resected whereas periampullary lesions need to be addressed surgically. As an individualized therapeutic approach the possibility of a combined endoscopic and laparoscopic resection technique exists. Follow-up endoscopic investigations are necessary, especially in gastric type 1 NENs, which have a tendency to relapse.

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Authors and Affiliations

  1. Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie (einschließlich Arbeitsbereich Stoffwechselerkrankungen), Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    S. Maasberg, C. Jürgensen, R. Pschowski, S. Felder, B. Wiedenmann &  U.-F. Pape

  2. Klinik für Gastroenterologie und Hepatologie, Klinikum Neuperlach, Städtisches Klinikum München, München, Deutschland

    F. Scheerer

  3. Klinik für Allgemein-, Viszeral- und minimalinvasive Chirurgie, Kreiskrankenhaus Stadthagen, Klinik Schaumburg, Stadthagen, Deutschland

    N. Begum

  4. Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Deutschland

    A. Pascher

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  1. S. Maasberg
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  2. C. Jürgensen
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  3. F. Scheerer
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  4. R. Pschowski
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  5. S. Felder
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  6. N. Begum
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  7. B. Wiedenmann
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  8. A. Pascher
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  9. U.-F. Pape
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Correspondence to U.-F. Pape.

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Maasberg, S., Jürgensen, C., Scheerer, F. et al. Endoskopische Therapie gastroduodenaler neuroendokriner Neoplasien. Chirurg 87, 271–279 (2016). https://doi.org/10.1007/s00104-016-0157-6

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