Stellenwert endoskopischer Verfahren in der Therapie des Ösophaguskarzinoms - Vergleich von kurativen und palliativen Therapiekonzepten

Introduction The epidemiology in terms of incidence and prevalence of esophageal carcinoma is impressive. In Germany this entity causes about 3% of all cancer related deaths among men and 1% among women. Different endoscopic methods are used in palliative or curative treatment strategies with a relevant morbidity and need for recurrent interventions. In this study we want to analyse endoscopic procedures used at “Gemeinschaftsklinikum Mittelrhein am Standort Kemperhof Koblenz” for getting a better understanding of value, chances of success and risks of endoscopic treatment in the complex management of esophageal carcinoma. Patients and approach In this study those patients were included, which got their first diagnosis of esophageal carcinoma in 2007-2010 and which were treated by our gastroenterologists or surgeons. A total of 98 patients were included with 300 endoscopic treatments among 68 patients. 37 patients had an adenocarcinoma, 58 had a squamous-cell-carcinoma, 1 patient was suspected of having a “barrett”-carcinoma without histological proof and 2 patients had 2 synchronous tumors (adeno- and squamous-cell-carcinoma). We registered in retrospect general data of the population (demography, health status, stage of cancer and therapy concept) and the endoscopic interventions. We subsumed the interventions in type, indication and curative or palliative intention of an endoscopic treatment and analysed the complication rate and the efficiency as period of time between endoscopic treatments. For data analysis we used „SPSS 21.0“ for Mac. Quintessence The used endoscopic methods differ significant between both cancer entities (adeno- and squamous-cell-carcinoma). Endoscopic methods had in those indications only a few severe complications. Methods such as providing a sure enteral nutrition or stent implantation are most efficient – relating to the period of time without recurrent intervention. Methods of recovery of enteral nutrition are less efficient. Severity of complication and type of intervention correlate significant with the intention: in curative and in palliative treatment methods for recovery of nutrition were the most often used interventions. Discussion Choice of intervention depends on outside influences - particularly the tumor entity - and only to some extent on the examiner. Efficient methods with longer intervals between each procedure should be used to avoid risky interventions. The risk of complication of each method should be calculated individually. Of course a multimodal treatment can be considered with combination of advantages and disadvantages of each method (risk versus period of time without intervention). In synopsis endoscopic methods for treatment of esophageal cancer are safe and efficient – the latter especially with methods of providing a sure enteral nutrition and stent treatment. Both tumor entity and the (curative or palliative) intention of a therapy affect relevant the choice of method.