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Endoskopie heute 2008; 21(1): 37-51
DOI: 10.1055/s-2008-1004652
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Dünndarmkapselendoskopie 2006 / 2007 mit Literaturübersicht und Empfehlungen zur klinischen Anwendung der Dünndarmkapselendoskopie - Ergebnisse einer internationalen Experten-Diskussion

Literature Review and Recommendations for Clinical Application of Small-bowel Capsule Endoscopy, Based on a Panel Discussion by International Experts - Consensus Statements for Small-bowel Capsule Endoscopy, 2006 / 2007K. Mergener1 , T. Ponchon2 , I. Gralnek3 , M. Pennazio4 , G. Gay5 , W. Selby6 , E. G. Seidman7 , C. Cellier8 , J. Murray9 , R. de Franchis10 , T. Rösch11 , B. S. Lewis12
  • 1Digestive Health Specialists, Tacoma, Washington, USA
  • 2Hôpital Edouard Herriot, Lyon, France
  • 3Technion Israel Institute of Technology, Rambam Medical Center, Haifa, Israel
  • 4S. Giovanni A. S. Hospital, Turin, Italy
  • 5Hôpitaux de Brabois, CHU de Nancy, France
  • 6AW Morrow Gastroenterology and Liver Center, Royal Prince Alfred Hospital, Sydney, Australia
  • 7McGill University Health Center, Montreal, Canada
  • 8European Georges Pompidou Hospital, Paris, France
  • 9Mayo Clinic, Rochester, Minnesota, USA
  • 10University of Milan, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
  • 11Central Interdisciplinary Endoscopy Unit, Charité Campus Virchow, Department of Gastroenterology, Berlin, Germany
  • 12Mount Sinai Medical Center, New York, USA
Further Information

Publication History

Publication Date:
22 February 2008 (online)

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Grundlagen und Methoden

Der folgende Übersichtsartikel basiert auf zwei Tagungen, die anlässlich der von GIVEN Imaging unterstützten jährlichen internationalen Konferenz zur Kapselendoskopie (International Conference on Capsule Endoscopy, ICCE) stattfanden: erster Teil in Miami im März 2006, zweiter Teil in Paris im Juni 2006.

Zum Erreichen eines Konsenses über die Indikationen, Ergebnisse und Erfolgsraten wurden fünf bis sieben Experten, die von einem Vorsitzenden für jedes der einzelnen Themen ausgewählt wurden gebeten, Konsensaussagen in folgenden sechs verschiedenen Bereichen zu überprüfen und zu verändern: Darmvorbereitung und Prokinetika (beide Themen von einer Gruppe bearbeitet), obskure gastrointestinale Blutung, Dünndarmtumoren, chronisch entzündliche Darmerkrankungen und Zöliakie. In jeder der fünf Gruppen bereiteten zwei Experten die wichtigsten Fragen und Antworten zu relevanten Problemen im jeweiligen Bereich vor. Ebenso wurde die Literatur aufgearbeitet, die im Vorfeld den anderen Teilnehmern zugesandt worden war.

Diese Fragen wurden dann in den Expertengruppen diskutiert und endgültige Aussagen wurden erarbeitet. Das Manuskript auf der Grundlage dieser Angaben wurde dann an die Experten für Kommentare und Änderungen versandt. In dieser Sitzung wurden nur Teilaspekte der Dünndarmkapselendoskopie diskutiert, wie z. B. die Maßnahmen zur Darmvorbereitung. Andere Aspekte (vor allem Komplikationen und Risiken) wurden bei diesem Expertentreffen nicht behandelt.

Zur Belegung der Evidenz als Grundlage für die Entscheidungsfindung in den Expertengruppen wurden in dieser Übersichtsarbeit nur Originalarbeiten in peer-reviewed Zeitschriften und Abstracts von den beiden großen Gastroenterologie-Kongressen (Digestive Diseases Week [DDW], United European Gastroenterology Week [UEGW]) zitiert, wenn diese als wissenschaftlich adäquat eingeordnet und in den letzten zwei Jahren veröffentlicht worden waren. Ergebnisse wichtiger, bis zum Sommer 2007 publizierter Forschungsprojekte, fanden während der Bearbeitung des Manuskripts Berücksichtigung. Sie wurden trotz des bereits beendeten Expertentreffens in diese Publikation aufgenommen, um aktuelle Konsensaussagen zu gewährleisten, insbesonders wenn sich neue Erkentnisse als praktisch relevant erwiesen. Ein häufiges Problem in der Methodik der Studien zur Kapselendoskopie ist das Fehlen eines zuverlässigen Goldstandards. Seit vielen Jahren in der klinischen Forschung verwendete Begriffe wie Sensitivität, Spezifität, prädiktive Werte etc. wurden durch Surrogatparameter wie „Ausbeute” („yield”) ersetzt, die offensichtlichen Einschränkungen in der Aussagekraft unterliegen. Mit der Einführung der Doppelballon-Enteroskopie (DBE), ist ein möglicherweise zuverlässigerer Goldstandard vorhanden. Jedoch fehlen bisher verlässliche Studienergebnisse, da die Untersuchungsserien der DBE eine ähnliche Methodik verwenden und der gesamte Dünndarm nur bei einer kleinen Minderheit der Fälle untersucht wird.

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Prof. Dr. med. H.-J. Schulz

Klinik für Innere Medizin I · Sana-Klinikum Lichtenberg

Fanningerstraße 32

10365 Berlin

Phone: 0 30 / 55 18 22 10

Fax: 0 30 / 55 18 22 50

Email: hj.schulz@sana-kl.de