Z Gastroenterol 2005; 43(8): 737-749
DOI: 10.1055/s-2005-858258
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Endosonographie bei chronischer Pankreatitis

Endoscopic Ultrasound in Chronic PancreatitisC. Jenssen1 , C. F. Dietrich2
  • 1Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen
  • 2Innere Medizin 2, Caritas-Krankenhaus Bad Mergentheim
Further Information

Publication History

Manuskript eingetroffen: 21.11.2004

Manuskript akzeptiert: 29.3.2005

Publication Date:
09 August 2005 (online)

Zusammenfassung

In der Diagnostik und Therapieplanung bei chronischer Pankreatitis hat die Endosonographie vor dem Hintergrund der im Vergleich zur ERCP ungleich niedrigeren Komplikationsrate zunehmend an Bedeutung gewonnen, ohne allerdings alle diagnostischen Probleme zu lösen. Aufgrund der sehr hohen diagnostischen Genauigkeit, die sich auf die gleichzeitige Beurteilbarkeit von Parenchym- und Gangkriterien gründet, wird sie von einigen Autoren bereits als neue morphologische Goldstandardmethode gesehen. Voraussetzung für einen breiten Einsatz der Endosonographie als morphologische Goldstandardmethode für die Diagnostik bei chronischer Pankreatitis ist sowohl die Einigung auf einen zur Cambridge-Klassifikation kompatiblen Kriterien- und Graduierungskatalog als auch eine intensive Untersucherausbildung. Die Einordnung endosonographischer isolierter Parenchymkriterien mit Ausnahme von Kalzifikationen als Frühzeichen der chronischen Pankreatitis bedarf allerdings der kritischen Wertung. Schwächen der Methode liegen bei Fragestellungen wie der Abgrenzung von Frühformen der chronischen Pankreatitis gegen Altersveränderungen, Residuen einer akuten Pankreatitis und diffuser alkoholtoxischer Fibrose, der Differenzierung echoarmer Raumforderungen bei chronischer Pankreatitis sowie zystischer Pankreasläsionen, für die die konkurrierenden bildgebenden Methoden allerdings ebenfalls eine unzureichende diagnostische Genauigkeit aufweisen. In der interdisziplinären Planung und Durchführung der Therapie von Pseudozysten, peripankreatischen Nekrosen, Pankreasgangobstruktionen, Gallengangstenosen und Pankreatikolithiasis leistet die Endosonographie allerdings schon heute einen wesentlichen Beitrag.

Abstract

Endoscopic ultrasound has continuously gained importance and has proven to be of clinical value in patients with chronic pancreatitis. In addition, the much lower complication rate when compared to ERCP has to be recognised. Some authors have indicated that endoscopic ultrasound in the evaluation of chronic pancreatitis is the imaging method of choice, depending on both ductal and parenchymal criteria, but there are still some limitations. The two major limitations of EUS preventing it being the “gold standard” in patients with chronic pancreatitis are the lack of standard criteria to be used, and adequate education. Endoscopic ultrasound is difficult to learn and therefore teaching has to be standardised. A general acceptance of the staging of chronic pancreatitis using a catalogue based on criteria compatible to the Cambridge classification is required. Difficulties in evaluating parenchymal criteria with the exception of “indicative” calcifications, depend on the differentiation of the normal ageing process from sequelae of acute pancreatic, ethyl-toxic fibrosis and early stages of chronic pancreatitis. In addition, the differentiation of hypoechoic and cystic lesions as inflammatory changes or neoplastic tumours is still difficult; complementary imaging methods also have low sensitivity in this area. In conclusion, there is no doubt that endoscopic ultrasound has proven to be of value using an interdisciplinary approach in the evaluation and therapy of pseudocysts, peripancreatic necrosis, and pancreatic and bile duct obstruction.

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Prof. Dr. Christoph F. Dietrich

Innere Medizin 2, Caritas-Krankenhaus Bad Mergentheim

Uhlandstraße 7

97980 Bad Mergentheim

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Fax: ++ 49/79 31/58 22 90

Email: christoph.dietrich@ckbm.de