Gastrointestinale Endoskopie – erweiterte Bildgebung

Kernaussagen

Diagnostischer Zugewinn und Weiterbildung

• Neue Techniken der endoskopischen Diagnostik entwickeln sich in rasanter Geschwindigkeit. Die moderne Endoskopie hat als Hauptziel, Krebsvorstufen früh zu erkennen, um unmittelbar eine gezielte und definitive endoskopische Therapie einleiten zu können. Bei diesem Ziel führt kein Weg an den dargestellten neuen Technologien vorbei.

• Die Komplexität der gastrointestinalen Endoskopie hat durch die neuen Techniken erheblich zugenommen, und kein Endoskopiker wird sich einer intensiven Weiterbildung unabhängig von der verwendeten Technik verschließen können. Die zusätzlich gewonnenen optischen Details der neuen Technologien werden entscheidend dazu beitragen, die Effizienz der Diagnostik und Therapie der gastrointestinalen Endoskopie zu verbessern.

Hochauflösende Endoskopie, klassische und virtuelle Chromoendoskopie

• Die hochauflösende Endoskopie ist die entscheidende Weiterentwicklung der gastrointestinalen Endoskopie, da die Auflösung der Bilder erheblich gesteigert werden konnte. Dies hat eine unmittelbare Konsequenz, da die neuen sichtbaren Oberflächendetails zu einer verbesserten Detektion von flachen Veränderungen führen und die Dignitätsvorhersage der verschiedenen Läsionen mit höherer Zuverlässigkeit getroffen werden kann.

• Die Filtertechnologien unterstützen dabei die Charakterisierung von Läsionen und die sog. virtuelle Chromoendoskopie ist dabei, die klassische Chromoendoskopie abzulösen, da die Effektivität vergleichbar ist bei geringerem Zeitaufwand. Trotzdem hat die Chromoendoskopie für einzelne Indikationen (z. B. Colitis ulcerosa) einen berechtigten Stellenwert.

Endomikroskopie

• Die Endomikroskopie ist die entscheidende Weiterentwicklung der gastrointestinalen Endoskopie der letzten Jahrzehnte. Zum ersten Mal ist es möglich, die Schleimhaut des Magen-Darm-Traktes mikroskopisch zu untersuchen. Dies hat fundamentale Konsequenzen. Es wird nicht nur die Histologie noch während der laufenden Endoskopie ermöglicht, vielmehr können einzelne Erkrankungen erstmalig verlässlich diagnostiziert werden (z. B. mikroskopische Kolitis), und physiologische und pathophysiologische Prozesse können erstmalig beim Menschen beobachtet werden.

• Die Endomikroskopie führt zu der Option der molekularen Bildgebung, die in einzelnen Studien schon Realität ist und sich in den kommenden Jahren in Abhängigkeit von den ausstehenden Forschungsergebnissen rasch verbreiten könnte.

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