Kernaussagen
Methoden der Dünndarmdiagnostik
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Mittels Push-Enteroskopie können zwischen 50 und 100 cm des Dünndarms distal des Magens eingesehen werden.
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Hauptindikation zur Durchführung einer Dünndarmkapselendoskopie ist die obskure gastrointestinale Blutung.
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Eine signifikante Verbesserung der diagnostischen Ausbeute der Kapselendoskopie durch den Einsatz von Darmlavagelösungen und Prokinetika ist nicht belegt.
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Einzige absolute Kontraindikation zur Durchführung einer Kapselendoskopie ist die intestinale Stenose.
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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
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Angiodysplasien stellen mit 80 % die häufigste Blutungsursache dar.
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Die diagnostische Ausbeute der Kapselendoskopie beträgt etwa 60 %.
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Die Kapselendoskopie ist allen radiologischen Verfahren in der Diagnostik der chronischen obskuren Blutung signifikant überlegen.
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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.
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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.
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Im Vergleich zur Kapselendoskopie weist die Doppelballonenteroskopie eine tendenziell höhere diagnostische Ausbeute auf, vorausgesetzt es erfolgt eine komplette Enteroskopie.
Morbus Crohn
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Bei etwa 20 % der Crohn-Patienten liegt ein selektiver Dünndarmbefall vor.
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Die Kapselendoskopie ist allen radiologischen Verfahren in der Detektion von mukosalen Veränderungen signifikant überlegen.
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Radiologische Verfahren wie der CT- oder MR-Sellink erlauben zusätzlich eine Darstellung von extraintestinalen Befunden, Fisteln und Abszessen.
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Dünndarmstenosen können häufig mittels Doppelballonenteroskopie effektiv therapiert werden.
Polyposis-Syndrome
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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.
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Die Doppelballonenteroskopie ermöglicht eine endoskopische Therapie von Polypen im Bereich des mittleren Dünndarms.
Dünndarmtumore und Sprue
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Dünndarmtumore gehören zu den relevanten Befunden in allen größeren Kapselendoskopiestudien.
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Etwa 60 % der detektierten Tumore sind maligne, in etwa 50 % handelt es sich um Metastasen.
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Häufigstes Leitsymptom von Dünndarmtumoren ist die gastrointestinale Blutung.
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Die Sprue wird in etwa 1 % aller Untersuchungen mittels Doppelballonenteroskopie und Kapselendoskopie als Zufallsbefund erhoben.
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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
