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DOI: 10.1055/s-0028-1103007
© Georg Thieme Verlag Stuttgart · New York
Die Vorsorgekoloskopie: Standards und Perspektiven – Virtuelle Chromoendoskopie als Methode der Zukunft?
Screening coloscopy: standards and perspectives – Virtual chromoendoscopy as approach for the future?Publication History
Publication Date:
30 October 2008 (online)
![](https://www.thieme-connect.de/media/klinikarzt/200809/lookinside/thumbnails/10.1055-s-0028-1103007-1.jpg)
Vor 5 Jahren wurde die Koloskopie für Personen ab dem 56. Lebensjahr in das deutsche Krebsfrüherkennungsprogramm aufgenommen. Die Vorsorgekoloskopie erwies sich mittlerweile als eine effektive, von den Patienten gut akzeptierte Methode, die in ersten Analysen kosteneffektiv zu sein scheint. Um das Potenzial dieser Präventionsmaßnahme voll auszuschöpfen, sind allerdings Strategien wünschenswert, mit deren Hilfe die Detektionsrate von Adenomen optimiert werden könnte. Zwar erwies sich die klassische Chromoendoskopie mit Färbemitteln als nützlich, in der Praxis ist die Anwendung der Methode allerdings eher umständlich. Jedoch gibt es heute, beispielsweise mit der virtuellen Chromoendoskopie, innovative und vielversprechende Ansätze im Bereich der endoskopischen Bildverarbeitung, deren Wertigkeit aber durch weitere Studien zu evaluieren sein wird.
In Germany screening colonoscopy was introduced into the national program on colorectal cancer prevention 5 years ago. Screening colonoscopy has proved to be an effective and well–accepted method. Preliminary data suggest net savings from colorectal cancer prevention that compensate for the costs of screening. To optimize the potential of colonoscopy for the prevention of colorectal cancer strategies to enhance the adenoma detection rate need to be employed. Conventional chromoendoscopy with dye spraying might be helpful but it is time consuming and cumbersome to handle. There are some innovative promising imaging techniques that need to be evaluated in future studies.
Key words
colonoscopy - adenoma - chromoendoscopy - narrow band imaging - Fujinon intelligent chromoenhancement
Literatur
- 1 Winawer SJ, Zauber AG, Ho MN. et al. . Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993; 329 1977-1981
- 2 Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland. .Projekt wissenschaftliche Begleitung von Früherkennungs–Koloskopien in Deutschland. Berichtszeitraum 2005, 3. Jahresbericht, 20. Juni. 2007
- 3 Fietkau R, Zettl H, Klocking S, Kundt G.. Incidence, therapy and prognosis of colorectal cancer in different age groups. A population–based cohort study of the Rostock Cancer Registry. Strahlenther Onkol. 2004; 180 478-487
- 4 Sieg A, Brenner H.. Cost–saving analysis of screening colonoscopy in Germany. Z Gastroenterol. 2007; 45 945-951
- 5 Sieg A.. Propofol sedation in outpatient colonoscopy by trained practice nurses supervised by the gastroenterologist: a prospective evaluation of over 3000 cases. Z Gastroenterol. 2007; 45 697-701
- 6 Rex DK, Cutler CS, Lemmel GT. et al. . Colonoscopic miss rates of adenomas determined by back–to–back colonoscopies. Gastroenterology. 1997; 112 24-28
- 7 Robertson DJ, Greenberg ER, Beach M. et al. . Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005; 129 34-41
- 8 Barclay RL, Vicari JJ, Doughty AS. et al. . Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006; 355 2533-2541
- 9 Rembacken BJ, Fujii T, Cairns A. et al. . Flat and depressed colonic neoplasms: a prospective study of 1 000 colonoscopies in the UK. Lancet. 2000; 355 1211-1214
- 10 Saitoh Y, Waxman I, West B. et al. . Prevalence and distinctive biologic features of flat colorectal adenomas in a north American population. Gastroenterology. 2001; 120 1657-1665
- 11 Tsuda S, Veress B, Toth E, Fork FT.. Flat and depressed colorectal tumours in a southern Swedish population: a prospective chromoendoscopic and histopathological study. Gut. 2002; 51 550-555
- 12 Brooker JC, Saunders BP, Shah SG. et al. . Total colonic dye–spray increases the detection of diminutive adenomas during routine colonoscopy: a randomized controlled trial. Gastrointest Endosc. 2002; 56 333-338
- 13 Le Rhun M, Coron E, Parlier D. et al. . High resolution colonoscopy with chromoscopy versus standard colonoscopy for the detection of colonic neoplasia: a randomized study. Clin Gastroenterol Hepatol. 2006; 4 349-354
- 14 Lapalus MG, Helbert T, Napoleon B. et al. . Does chromoendoscopy with structure enhancement improve colonoscopic adenoma detection rate?. Endoscopy. 2006; 38 444-448
- 15 Pohl J, May A, Rabenstein T, Pech O.. Computed virtual chromoendoscopy: a new tool for enhancing tissue surface structures. Endoscopy. 2007; 39 80-83
- 16 Chiu HM, Chang CY, Chen CC. et al. . A prospective comparative study of narrow band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut. 2007; 56 373-379
- 17 Su MY, Hsu CM, Ho YP. et al. . Comparative study of conventional colonoscopy, chromoendoscopy, and narrow–band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps. Am J Gastroenterol. 2006; 101 2711-2716
- 18 Pohl J, Nguyen–Tat M, Pech O. et al. . Computed virtual chromoendoscopy for classification of small colorectal lesions: A prospective comparative study. Am J Gastroenterol. 2007; 102 1-8
- 19 Rex DK, Helbig CC.. High yields of small and flat adenomas with high–definition colonoscopes using either white light or narrow band imaging. Gastroenterology. 2007; 133 42-47
- 20 Adler A, Pohl H, Papanikolaou IS. et al. . A prospective randomized study on narrow–band imaging versus conventional colonoscopy for adenoma detection: does NBI induce a learning effect?. Gut. 2008; 57 59-64
1 Union Internationale Contre le Cancer Korrespondenz
PD Dr. Jürgen Pohl
Medizinische Klinik II – Gastroenterologie HSK Dr.–Horst–Schmidt–Klinik
Ludwig–Erhard–Straße 100
65199 Wiesbaden
Email: pohljuergen@web.de