Videokapselendoskopie – Die mittlere gastrointestinale Blutung – Neues 2010

Zusammenfassung

In den Leitlinien der European Society of Gastrointestinal Endoscopy (ESGE) werden die Videokapselendoskopie (VKE) und die Doppelballon-Enteroskopie (DBE) als sich ergänzende Verfahren zur Detektion von Blutungen im mittleren Gastrointestinaltrakt festgelegt. Die Empfehlung geht dahin, dass bei einer hohen Wahrscheinlichkeit einer Intervention, z. B. im Falle einer schweren und wahrscheinlich noch aktiven Blutung die DBE der VKE vorzuziehen ist. Die VKE ist nach wie vor eine gute Indikation bei okkulten Blutungen insbesondere bei einer Eisenmangelanämie. In diesem Falle kann sie als „Screening-Methode“ eingesetzt werden [20]. Die Wiederholung der Ösophago-Gastro-Duodenoskopie und Ileokoloskopie ist bei vorangegangenen unauffälligen Untersuchungen, wie von Rösch und Ell 2004 [21] dokumentiert, ratsam. Eine neuere Studie unterstreicht weiterhin dieses Vorgehen zum Schutz der Patienten. Eine Multi-Detektor-Computertomografie (MDCT) ist der VKE zur Detektion von Dünndarmläsionen statstisch nicht signifikant überlegen. Ein Verbesserung der Videoauswertesoftware durch ein „Probabilistic Neural Network“ könnte in Zukunft zur bessere und damit rascheren Detektion des „Suspected blood indicators“ führen.

Abstract

Video capsule endoscopy (VKE) and double balloon enteroscopy (DBE) are established complementary methodes for detection af haemorrhages in the middle GI-tract as published by guidelines of the European Society of Gastrointestinal Endoscopy (ESGE). In profunde and active haemorrhages the recommendation are to prefere DBE be­fore VKE because of the likelihood of a subsequent intervention. In occult haemorrhages especially in iron deficiency anemia VKE is a recommended procedure. In this case it can be employed as a screening procedure. The repeated esophago­gastroduodenoscopy and ileocolonoscopy in previously normal investigations is recommended [21]. A new study emphasises this as an addi­tional protection of the patients. In the detection of small bowel lesions Multi-detector-computed-tomography ist statistically not superior to VKE. Improvement of video software analysis by “Probabilistic Neural Network” could lead to faster and better detection of “Suspected blood indicators”.

Schlüsselwörter

mittlere gastrointestinale Blutung - Videokapselendoskopie - obskure Blutung

Key words

video capsule endoscopy - mid gastrointestinal bleeding - obscure bleeding

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