Zusammenfassung
Es wird ein Überblick gegeben über Häufigkeiten und gewisse Charakteristika von Dünndarmtumoren (DDT) in der Videokapselendoskopie (VKE). Histologische Sicherung ist erforderlich – Möglichkeiten für das endoskopische Vorgehen werden dargestellt. In über 80 % der Fälle werden DDT über die Indikation mittlere GIB gefunden. Aktuelle Meinungen zur Indikation der VKE bei bestimmten Krankheitsbildern werden vorgestellt und Überlegungen angestellt über weitere sinnvolle Indikationen. Zusammenfassend gibt es eine klare Indikation für die Durchführung einer VKE beim PJS und anderen hamartomösen Polyposis-Syndromen, allein schon aus Strahlenschutzgründen der meist jungen Patienten. In der Überwachung der FAP wird die VKE mindestens ab Spigelman IV empfohlen. Einleuchtend erscheint die Kontrolle nach Therapie eines Dünndarmadenoms oder Karzinoms entsprechend den Leitlinien für kolorektale Polypen und Karzinome. In Einzelfällen kann bei Metastasen im Dünndarm die VKE unter palliativen Gesichtspunkten sinnvoll sein. Bei allen anderen im Text genannten möglichen Indikationen für die gezielte Durchführung einer VKE bleibt die weitere Entwicklung der Datenlage abzuwarten.
Abstract
The prevalence of small bowel tumors found at capsule endoscopy (CE) is reported to be 2.4 % of the examinations. Over half of the tumors were malignant. More than 80 % of small bowel tumours diagnosed by CE were detected in patients with gastrointestinal bleeding. This article describes clinical presentation and some characteristics of small bowel tumors and tries to update the role for CE in patients with special situations. Radiation-free CE should be preferred for surveillance in syndromes with hamartomatous polyps and is recommended in patients with FAP with duodenal polyps. In some cases with metastases CE enables localisation for palliative surgical treatment. Further possible indications with only few data are: duodenal adenomas without FAP, surveillance of patients with surgical or endoscopic resection of small intestinal adenomas or carcinomas, HNPCC. Frequent extraluminal tumor growth limits the indication in patients with neuroendocrine tumors (NET) – but CE should be taken into account prior to surgery in patients with non-metastatic disease with supposed single tumor, because in patients with NET often multiple tumors occur. In patients with lymphomas CE detects different lesions. Remission after chemotherapy can be documented. This may be helpful in staging and restaging. Further data will be needed.
Schlüsselwörter
Kapselendoskopie - Dünndarmtumore - Indikationen - Polyposis-Syndrome - Lymphome
Key words
capsule endoscopy - small bowel tumors - indications - polyposis syndromes - lymphomas
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Dr. med. F. Wiedbrauck
Klinik für Gastroenterologie · Allgemeines Krankenhaus Celle
Siemensplatz 4
29223 Celle
Email: felix.wiedbrauck@akh-celle.de
