Endoskopische Diagnostik und Therapie des Magenkarzinoms

Endoscopy plays a central role in both the diagnosis of gastric cancer and in the treatment of early-stage disease.

Over the past two decades, the diagnostic and therapeutic options of gastrointestinal endoscopy have significantly improved, especially for early gastric cancer. Technical developments (e.g., virtual chromoendoscopy and resection techniques such as endoscopic submucosal dissection) facilitate diagnosis and enable R0 resection of even larger early neoplasms. Furthermore, a solid evidence base is now available regarding the oncological characteristics of early gastric cancers. Expanded resection criteria could be defined in larger studies, which allow endoscopic resection as a minimally invasive and curative treatment option for selected early gastric cancers. Relevant parameters regarding the decision for or against endoscopic resection are lesion size, ulceration, invasion depth, degree of differentiation, and presence or absence of lymphovascular invasion. Guidelines from national and international societies give clear treatment recommendations. However, due to the lack of screening programs, fewer than 20% of gastric cancers are diagnosed at an early stage in Germany.

Endoscopic treatment of early gastric cancer has dramatically improved with the introduction of endoscopic submucosal dissection. Oncological criteria must be considered when establishing the indication. The diagnosis of gastric cancer in early stages needs to be improved in Western countries.