Gastroenterologie up2date 2008; 4(1): 73-99
DOI: 10.1055/s-2007-995584
Endoskopie/Gastrointestinale Radiologie/Sonographie

© Georg Thieme Verlag Stuttgart · New York

Innovative endoskopische Dünndarmdiagnostik

Nicola  Plum, Hendrik  Manner, Christian  Ell
Further Information

Publication History

Publication Date:
07 March 2008 (online)

Kernaussagen

Methoden der Dünndarmdiagnostik

  • Mittels Push-Enteroskopie können zwischen 50 und 100 cm des Dünndarms distal des Magens eingesehen werden.

  • Hauptindikation zur Durchführung einer Dünndarmkapselendoskopie ist die obskure gastrointestinale Blutung.

  • Eine signifikante Verbesserung der diagnostischen Ausbeute der Kapselendoskopie durch den Einsatz von Darmlavagelösungen und Prokinetika ist nicht belegt.

  • Einzige absolute Kontraindikation zur Durchführung einer Kapselendoskopie ist die intestinale Stenose.

  • Eine komplette Enteroskopie mittels Doppelballonenteroskopie gelingt bei 60-80 % der Patienten. Meist ist dabei eine Kombination von oralem und analem Zugangsweg erforderlich. Limitationen ergeben sich hauptsächlich durch Verwachsungen nach abdominellen Operationen.

Obskure gastrointestinale Blutung

  • Angiodysplasien stellen mit 80 % die häufigste Blutungsursache dar.

  • Die diagnostische Ausbeute der Kapselendoskopie beträgt etwa 60 %.

  • Die Kapselendoskopie ist allen radiologischen Verfahren in der Diagnostik der chronischen obskuren Blutung signifikant überlegen.

  • Bei 30-80 % der Patienten mit positiven Kapselendoskopiebefunden ergibt sich eine therapeutische Konsequenz. 70 % der therapierten Patienten zeigen eine Verbesserung des Langzeitverlaufes, gemessen an Transfusionsbedarf, Anzahl der Rezidivblutungen und Hospitalisierungsrate.

  • Die akute, kreislaufrelevante obskure gastrointestinale Blutung ist keine Indikation zur Durchführung einer Dünndarmkapselendoskopie. Hier ist die klassische Angiographie neben der intraoperativen Endoskopie Methode der Wahl.

  • Im Vergleich zur Kapselendoskopie weist die Doppelballonenteroskopie eine tendenziell höhere diagnostische Ausbeute auf, vorausgesetzt es erfolgt eine komplette Enteroskopie.

Morbus Crohn

  • Bei etwa 20 % der Crohn-Patienten liegt ein selektiver Dünndarmbefall vor.

  • Die Kapselendoskopie ist allen radiologischen Verfahren in der Detektion von mukosalen Veränderungen signifikant überlegen.

  • Radiologische Verfahren wie der CT- oder MR-Sellink erlauben zusätzlich eine Darstellung von extraintestinalen Befunden, Fisteln und Abszessen.

  • Dünndarmstenosen können häufig mittels Doppelballonenteroskopie effektiv therapiert werden.

Polyposis-Syndrome

  • Sowohl die Kapselendoskopie als auch der MR-Sellink zeigen eine hohe Sensitivität für die Detektion von Dünndarmpolypen, wobei die Kapselendoskopie dem MR-Sellink bei der Detektion von Polypen < 15 mm überlegen ist.

  • Die Doppelballonenteroskopie ermöglicht eine endoskopische Therapie von Polypen im Bereich des mittleren Dünndarms.

Dünndarmtumore und Sprue

  • Dünndarmtumore gehören zu den relevanten Befunden in allen größeren Kapselendoskopiestudien.

  • Etwa 60 % der detektierten Tumore sind maligne, in etwa 50 % handelt es sich um Metastasen.

  • Häufigstes Leitsymptom von Dünndarmtumoren ist die gastrointestinale Blutung.

  • Die Sprue wird in etwa 1 % aller Untersuchungen mittels Doppelballonenteroskopie und Kapselendoskopie als Zufallsbefund erhoben.

  • In seltenen Fällen werden die Doppelballonenteroskopie und die Kapselendoskopie gezielt in der Diagnostik der therapierefraktären Sprue eingesetzt.

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Prof. Dr. Christian C. Ell

Dr. Horst-Schmidt-Kliniken

Innere Medizin II

Ludwig-Erhard-Straße 100

65199 Wiesbaden

Email: ell.hsk-wiesbaden@arcor.de