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DOI: 10.1055/s-0031-1291730
© Georg Thieme Verlag KG Stuttgart · New York
Rektale Endosonografie
Stellenwert und praktische Anwendung in der GastroenterologiePublikationsverlauf
Publikationsdatum:
14. März 2012 (online)

Kernaussagen
Rektumkarzinom
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Die rektale Endosonografie ist entsprechend der deutschen S3-Richtlinie (Evidenzstärke 2b, Empfehlungsgrad A, starker Konsens) obligat im Rahmen des präoperativen Stagings des Rektumkarzinoms.
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Sie ermöglicht eine Differenzierung auch von frühen Tumorstadien und erlaubt, einen Lymphknotenbefall durch Feinnadelpunktion zu sichern.
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Die konkurrierende MRT kann frühe Tumorstadien schlechter differenzieren, stellt aber die insbesondere bei fortgeschrittenen Tumoren wichtige mesorektale Faszie dar.
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Die Beurteilung einer Lymphknotenbeteiligung gelingt durch beide Methoden nicht befriedigend.
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Die Endosonografie kann in Kombination mit der EUS-gestützten Feinnadelpunktion Rezidive sichern, wird aber nicht routinemäßig zur Nachsorge empfohlen.
Fisteln und Abszesse
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Perianale Fisteln und Abszesse, z. B. bei Morbus Crohn, lassen sich endosonografisch mit hoher Sensitivität nachweisen, wodurch auch das therapeutische Vorgehen gesteuert werden kann.
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Auch EUS-gesteuerte diagnostische Punktionen und Therapie von Abszessen in Form einer EUS-gesteuerten transrektalen oder alternativ transvaginalen Drainage sind möglich.
Weitere Indikationen
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Darüber hinaus kommt die Endosonografie für den Nachweis von internen und externen Sphinkterdefekten und zur Beurteilung rektumnaher Endometrioseherde zum Einsatz.
Literatur
- 1
Wild J J, Reid J M.
Diagnostic use of ultrasound.
Br J Phys Med.
1956;
19
248-257
MissingFormLabel
- 2
Dragsted J, Gammelgaard J.
Endoluminal ultrasonic scanning in the evaluation of rectal
cancer: a preliminary report of 13 cases.
Gastrointest Radiol.
1983;
8
367-369
MissingFormLabel
- 3
Tio T L, Mulder C J, Tytgat G N.
[Colorectal endosonography of perianorectal
lesions].
Z Gastroenterol Verh.
1989;
24
47-49
MissingFormLabel
- 4
Law P J, Kamm M A, Bartram C I.
A comparison between electromyography and anal endosonography
in mapping external anal sphincter defects.
Dis Colon Rectum.
1990;
33
370-373
MissingFormLabel
- 5
Rifkin M D, Marks G J.
Transrectal US as an adjunct in the diagnosis of rectal and
extrarectal tumors.
Radiology.
1985;
157
499-502
MissingFormLabel
- 6
Giovannini M, Bories E, Moutardier V. et al .
Drainage of deep pelvic abscesses using therapeutic echo
endoscopy.
Endoscopy.
2003;
35
511-514
MissingFormLabel
- 7
Kapiteijn E, Marijnen C A, Nagtegaal I D. et al .
Preoperative radiotherapy combined with total mesorectal
excision for resectable rectal cancer.
N Engl J Med.
2001;
345
638-646
MissingFormLabel
- 8
Schmiegel W, Pox C, Adler G. et al .
S3-Leitlinie „Kolorektales Karzinom“.
Z Gastroenterol.
2008;
46
1-73
MissingFormLabel
- 9
Jurgensen C, Dietrich C F.
[Role of endoscopic ultrasound (EUS) in the staging of
rectal cancer].
Z Gastroenterol.
2008;
46
580-589
MissingFormLabel
- 10 Sobin L, Gospodarowicz M, Wittekind C. UICC: TNM classification of malignant tumors.. 7th ed. New York: Wiley-Liss; 2009
MissingFormLabel
- 11
Hizawa K, Suekane H, Aoyagi K. et al .
Use of endosonographic evaluation of colorectal tumor depth
in determining the appropriateness of endoscopic mucosal resection.
Am J Gastroenterol.
1996;
91
768-771
MissingFormLabel
- 12
Watanabe H, Miwa H, Terai T. et al .
Endoscopic ultrasonography for colorectal cancer using
submucosal saline solution injection.
Gastrointest Endosc.
1997;
45
508-511
MissingFormLabel
- 13
Harewood G C.
Assessment of publication bias in the reporting of EUS
performance in staging rectal cancer.
Am J Gastroenterol.
2005;
100
808-816
MissingFormLabel
- 14
Garcia-Aguilar J, Pollack J, Lee S H. et al .
Accuracy of endorectal ultrasonography in preoperative
staging of rectal tumors.
Dis Colon Rectum.
2002;
45
10-15
MissingFormLabel
- 15
Marusch F, Ptok H, Sahm M. et al .
Endorectal ultrasound in rectal carcinoma – do the
literature results really correspond to the realities of routine clinical
care?.
Endoscopy.
2011;
43
425-431
MissingFormLabel
- 16
Chapet O, Romestaing P, Mornex F. et al .
Preoperative radiotherapy for rectal adenocarcinoma: Which
are strong prognostic factors?.
Int J Radiat Oncol Biol Phys.
2005;
61
1371-1377
MissingFormLabel
- 17
Bianchi P P, Ceriani C, Rottoli M. et al .
Endoscopic ultrasonography and magnetic resonance in
preoperative staging of rectal cancer: comparison with histologic
findings.
J Gastrointest Surg.
2005;
9
1222-1227
discussion 1227–1228
MissingFormLabel
- 18
Fernandez-Esparrach G, Ayuso-Colella J R, Sendino O. et al .
EUS and magnetic resonance imaging in the staging of rectal
cancer: a prospective and comparative study.
Gastrointest Endosc.
2011;
74
347-354
MissingFormLabel
- 19
Marusch F, Koch A, Schmidt U. et al .
Routine use of transrectal ultrasound in rectal carcinoma:
results of a prospective multicenter study.
Endoscopy.
2002;
34
385-390
MissingFormLabel
- 20
Tepper J E, O’Connell M J, Niedzwiecki D. et al .
Impact of number of nodes retrieved on outcome in patients
with rectal cancer.
J Clin Oncol.
2001;
19
157-163
MissingFormLabel
- 21
Bittner R, Burghardt J, Gross E. et al .
[Report on the workshop „workflow rectal cancer
II“ in Burghausen].
Zentralbl Chir.
2007;
132
95-98
MissingFormLabel
- 22
Andreola S, Leo E, Belli F. et al .
Manual dissection of adenocarcinoma of the lower third of the
rectum specimens for detection of lymph node metastases smaller than
5 mm.
Cancer.
1996;
77
607-612
MissingFormLabel
- 23
Gleeson F C, Clain J E, Papachristou G I. et al .
Prospective assessment of EUS criteria for lymphadenopathy
associated with rectal cancer.
Gastrointest Endosc.
2009;
69
896-903
MissingFormLabel
- 24
Harewood G C, Wiersema M J, Nelson H. et al .
A prospective, blinded assessment of the impact of
preoperative staging on the management of rectal cancer.
Gastroenterology.
2002;
123
24-32
MissingFormLabel
- 25
Harewood G C, Kumar K S, Clain J E. et al .
Clinical implications of quantification of mesorectal tumor
invasion by endoscopic ultrasound: All T3 rectal cancers are not equal.
J Gastroenterol Hepatol.
2004;
19
750-755
MissingFormLabel
- 26
Jürgensen C, Teubner A, Habeck J O. et al .
Staging of rectal cancer by EUS: depth of infiltration in T3
cancers is important.
Gastrointest Endosc.
2011;
73
325-328
MissingFormLabel
- 27
Hall N R, Finan P J, al-Jaberi T. et al .
Circumferential margin involvement after mesorectal excision
of rectal cancer with curative intent.
Predictor of survival but not local recurrence? Dis Colon
Rectum.
1998;
41
979-983
MissingFormLabel
- 28
MERCURY Study Group .
Diagnostic accuracy of preoperative magnetic resonance
imaging in predicting curative resection of rectal cancer: prospective
observational study.
BMJ.
2006;
333
779
MissingFormLabel
- 29
Marone P, de Bellis M, Avallone A. et al .
Accuracy of endoscopic ultrasound in staging and restaging
patients with locally advanced rectal cancer undergoing neoadjuvant
chemoradiation.
Clin Res Hepatol Gastroenterol.
2011;
35
666-670
MissingFormLabel
- 30
Rau B, Hunerbein M, Barth C. et al .
Accuracy of endorectal ultrasound after preoperative
radiochemotherapy in locally advanced rectal cancer.
Surg Endosc.
1999;
13
980-984
MissingFormLabel
- 31
Novell F, Pascual S, Viella P. et al .
Endorectal ultrasonography in the follow-up of rectal cancer.
Is it a better way to detect early local recurrence?.
Int J Colorectal Dis.
1997;
12
78-81
MissingFormLabel
- 32
Lohnert M S, Doniec J M, Henne-Bruns D.
Effectiveness of endoluminal sonography in the identification
of occult local rectal cancer recurrences.
Dis Colon Rectum.
2000;
43
483-491
MissingFormLabel
- 33
Mascagni D, Corbellini L, Urciuoli P. et al .
Endoluminal ultrasound for early detection of local
recurrence of rectal cancer.
Br J Surg.
1989;
76
1176-1180
MissingFormLabel
- 34
Schwartz D A, Wiersema M J, Dudiak K M. et al .
A comparison of endoscopic ultrasound, magnetic resonance
imaging, and exam under anesthesia for evaluation of Crohn’s perianal
fistulas.
Gastroenterology.
2001;
121
1064-1072
MissingFormLabel
- 35
Spradlin N M, Wise P E, Herline A J. et al .
A randomized prospective trial of endoscopic ultrasound to
guide combination medical and surgical treatment for Crohn’s perianal
fistulas.
Am J Gastroenterol.
2008;
103
2527-2535
MissingFormLabel
- 36
Yang J, Abdel-Wahab M, Ribeiro A.
EUS-guided fiducial placement before targeted radiation
therapy for prostate cancer.
Gastrointest Endosc.
2009;
70
579-583
MissingFormLabel
- 37
Dobben A C, Terra M P, Slors J F. et al .
External anal sphincter defects in patients with fecal
incontinence: comparison of endoanal MR imaging and endoanal US.
Radiology.
2007;
242
463-471
MissingFormLabel
- 38
Delpy R, Barthet M, Gasmi M. et al .
Value of endorectal ultrasonography for diagnosing
rectovaginal septal endometriosis infiltrating the rectum.
Endoscopy.
2005;
37
357-361
MissingFormLabel
Dr. med. Christian Jürgensen
Klinik für Gastroenterologie, Hepatologie und
Endokrinologie
Charité Universitätsmedizin
Charitéplatz 1
10117 Berlin
eMail: Christian.Juergensen@charite.de