Diagnostische Endosonografie – State of the Art 2009[1]

Zusammenfassung

Erste Berichte über die endoluminale Ultraschalldiagnostik liegen 3 Jahrzehnte zurück. Inzwischen hat sich der endoskopische Ultraschall (EUS) von einer experimentellen Außenseiter­methode zu einer in Gastroenterologie, Visze­ralchirurgie, Pneumologie, Endokrinologie und ­Onkologie unverzichtbaren Methode etablieren können und gilt heute als interdisziplinäre „Königs­disziplin“ der Endoskopie [1]. Ein ent­schei­dender Meilenstein dieser Entwicklung war die Einführung elektronischer Longitudinalscanner als Voraussetzung für die endosonografisch gestützte Biopsie. Elektronische Longitudinal- und Radialscanner ermöglichten es darüber hinaus, innovative Ultraschalltechnologien wie farbkodierte Duplexsonografie, echosignalver­stärkte Sonografie und die Realtime-Elastografie auch endoluminal einzusetzen. Die Akzeptanz des EUS im klinischen Alltag gründet sich auf eine überzeugende wissenschaftliche Evidenz in den etablierten Indikationsgebieten und auf eine breite Verfügbarkeit in hoher Qualität. In Deutschland werden strukturierte Ausbildungscurricula und die vergleichende Bewertung der Ergebnisqualität (Benchmarking) helfen, den klinischen Stellenwert des EUS zu festigen.

Abstract

The first reports on endoluminal applications of diagnostic ultrasound have been published three decades ago. Meanwhile endoscopic ultrasound (EUS) is established as an indispensable method not only in gastroenterology, but also in visceral surgery, pneumology, endocrinology, and oncology. Today EUS is no longer an experimental method but is regarded to be the supreme discipline of interdisciplinary endoscopy [1]. One decisive milestone of this development was the introduction of electronic longitudinal echoendoscopes, which are the prerequisite for EUS-guided biopsy. Moreover electronic radial and longitudinal echoendoscopes allow for endoluminal application of innovative ultrasound technologies like color coded Duplex scanning, contrast enhanced ultrasound, and real-time elastography. The acceptance of EUS in daily clinical practice is based on convincing scientific evidence in the established fields of indication on the one hand and on general availability in high quality on the other. In Germany training curricula, quality assessment and benchmarking will help to ensure and develop the clinical significance of EUS.

Schlüsselwörter

Endosonografie - endoskopischer Ultraschall - EUS-FNA - Qualitätssicherung - Ausbildung

Key words

endosonography - endoscopic ultrasound - EUS-FNA - quality assessment - training

1 Diese Übersicht gründet sich auf einen State-of-the-Art-Vortrag des Autors beim 7. Euro-EUS-Kongress am 2. Mai 2009 in Berlin

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1 Diese Übersicht gründet sich auf einen State-of-the-Art-Vortrag des Autors beim 7. Euro-EUS-Kongress am 2. Mai 2009 in Berlin