Download PDF
Gastroenterologie up2date 2012; 8(1): 45-57
DOI: 10.1055/s-0031-1291730
Endoskopie/Gastrointestinale Radiologie/Sonografie

© Georg Thieme Verlag KG Stuttgart · New York

Rektale Endosonografie

Stellenwert und praktische Anwendung in der GastroenterologieChristian  Jürgensen
Further Information

Publication History

Publication Date:
14 March 2012 (online)

Also available at
    Permissions and Reprints All articles of this category

Updated by:

Rektale Endosonografie – Stellenwert in der GastroenterologieGastroenterologie up2date 2017; 13(02): 123-134
DOI: 10.1055/s-0043-110596

Kernaussagen

Rektumkarzinom

  • Die rektale Endosonografie ist entsprechend der deutschen S3-Richtlinie (Evidenzstärke 2b, Empfehlungsgrad A, starker Konsens) obligat im Rahmen des präoperativen Stagings des Rektumkarzinoms.

  • Sie ermöglicht eine Differenzierung auch von frühen Tumorstadien und erlaubt, einen Lymphknotenbefall durch Feinnadelpunktion zu sichern.

  • Die konkurrierende MRT kann frühe Tumorstadien schlechter differenzieren, stellt aber die insbesondere bei fortgeschrittenen Tumoren wichtige mesorektale Faszie dar.

  • Die Beurteilung einer Lymphknotenbeteiligung gelingt durch beide Methoden nicht befriedigend.

  • Die Endosonografie kann in Kombination mit der EUS-gestützten Feinnadelpunktion Rezidive sichern, wird aber nicht routinemäßig zur Nachsorge empfohlen.

Fisteln und Abszesse

  • Perianale Fisteln und Abszesse, z. B. bei Morbus Crohn, lassen sich endosonografisch mit hoher Sensitivität nachweisen, wodurch auch das therapeutische Vorgehen gesteuert werden kann.

  • Auch EUS-gesteuerte diagnostische Punktionen und Therapie von Abszessen in Form einer EUS-gesteuerten transrektalen oder alternativ transvaginalen Drainage sind möglich.

Weitere Indikationen

  • Darüber hinaus kommt die Endosonografie für den Nachweis von internen und externen Sphinkterdefekten und zur Beurteilung rektumnaher Endometrioseherde zum Einsatz.

Literatur

  • 1 Wild J J, Reid J M. Diagnostic use of ultrasound.  Br J Phys Med. 1956;  19 248-257
    Search in Google Scholar
  • 2 Dragsted J, Gammelgaard J. Endoluminal ultrasonic scanning in the evaluation of rectal cancer: a preliminary report of 13 cases.  Gastrointest Radiol. 1983;  8 367-369
    Search in Google Scholar
  • 3 Tio T L, Mulder C J, Tytgat G N. [Colorectal endosonography of perianorectal lesions].  Z Gastroenterol Verh. 1989;  24 47-49
    Search in Google Scholar
  • 4 Law P J, Kamm M A, Bartram C I. A comparison between electromyography and anal endosonography in mapping external anal sphincter defects.  Dis Colon Rectum. 1990;  33 370-373
    Search in Google Scholar
  • 5 Rifkin M D, Marks G J. Transrectal US as an adjunct in the diagnosis of rectal and extrarectal tumors.  Radiology. 1985;  157 499-502
    Search in Google Scholar
  • 6 Giovannini M, Bories E, Moutardier V. et al . Drainage of deep pelvic abscesses using therapeutic echo endoscopy.  Endoscopy. 2003;  35 511-514
    Search in Google Scholar
  • 7 Kapiteijn E, Marijnen C A, Nagtegaal I D. et al . Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.  N Engl J Med. 2001;  345 638-646
    Search in Google Scholar
  • 8 Schmiegel W, Pox C, Adler G. et al . S3-Leitlinie „Kolorektales Karzinom“.  Z Gastroenterol. 2008;  46 1-73
    Search in Google Scholar
  • 9 Jurgensen C, Dietrich C F. [Role of endoscopic ultrasound (EUS) in the staging of rectal cancer].  Z Gastroenterol. 2008;  46 580-589
    Search in Google Scholar
  • 10 Sobin L, Gospodarowicz M, Wittekind C. UICC: TNM classification of malignant tumors.. 7th ed. New York: Wiley-Liss; 2009
    Search in Google Scholar
  • 11 Hizawa K, Suekane H, Aoyagi K. et al . Use of endosonographic evaluation of colorectal tumor depth in determining the appropriateness of endoscopic mucosal resection.  Am J Gastroenterol. 1996;  91 768-771
    Search in Google Scholar
  • 12 Watanabe H, Miwa H, Terai T. et al . Endoscopic ultrasonography for colorectal cancer using submucosal saline solution injection.  Gastrointest Endosc. 1997;  45 508-511
    Search in Google Scholar
  • 13 Harewood G C. Assessment of publication bias in the reporting of EUS performance in staging rectal cancer.  Am J Gastroenterol. 2005;  100 808-816
    Search in Google Scholar
  • 14 Garcia-Aguilar J, Pollack J, Lee S H. et al . Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors.  Dis Colon Rectum. 2002;  45 10-15
    Search in Google Scholar
  • 15 Marusch F, Ptok H, Sahm M. et al . Endorectal ultrasound in rectal carcinoma – do the literature results really correspond to the realities of routine clinical care?.  Endoscopy. 2011;  43 425-431
    Search in Google Scholar
  • 16 Chapet O, Romestaing P, Mornex F. et al . Preoperative radiotherapy for rectal adenocarcinoma: Which are strong prognostic factors?.  Int J Radiat Oncol Biol Phys. 2005;  61 1371-1377
    Search in Google Scholar
  • 17 Bianchi P P, Ceriani C, Rottoli M. et al . Endoscopic ultrasonography and magnetic resonance in preoperative staging of rectal cancer: comparison with histologic findings.  J Gastrointest Surg. 2005;  9 1222-1227 discussion 1227–1228
    Search in Google Scholar
  • 18 Fernandez-Esparrach G, Ayuso-Colella J R, Sendino O. et al . EUS and magnetic resonance imaging in the staging of rectal cancer: a prospective and comparative study.  Gastrointest Endosc. 2011;  74 347-354
    Search in Google Scholar
  • 19 Marusch F, Koch A, Schmidt U. et al . Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study.  Endoscopy. 2002;  34 385-390
    Search in Google Scholar
  • 20 Tepper J E, O’Connell M J, Niedzwiecki D. et al . Impact of number of nodes retrieved on outcome in patients with rectal cancer.  J Clin Oncol. 2001;  19 157-163
    Search in Google Scholar
  • 21 Bittner R, Burghardt J, Gross E. et al . [Report on the workshop „workflow rectal cancer II“ in Burghausen].  Zentralbl Chir. 2007;  132 95-98
    Search in Google Scholar
  • 22 Andreola S, Leo E, Belli F. et al . Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm.  Cancer. 1996;  77 607-612
    Search in Google Scholar
  • 23 Gleeson F C, Clain J E, Papachristou G I. et al . Prospective assessment of EUS criteria for lymphadenopathy associated with rectal cancer.  Gastrointest Endosc. 2009;  69 896-903
    Search in Google Scholar
  • 24 Harewood G C, Wiersema M J, Nelson H. et al . A prospective, blinded assessment of the impact of preoperative staging on the management of rectal cancer.  Gastroenterology. 2002;  123 24-32
    Search in Google Scholar
  • 25 Harewood G C, Kumar K S, Clain J E. et al . Clinical implications of quantification of mesorectal tumor invasion by endoscopic ultrasound: All T3 rectal cancers are not equal.  J Gastroenterol Hepatol. 2004;  19 750-755
    Search in Google Scholar
  • 26 Jürgensen C, Teubner A, Habeck J O. et al . Staging of rectal cancer by EUS: depth of infiltration in T3 cancers is important.  Gastrointest Endosc. 2011;  73 325-328
    Search in Google Scholar
  • 27 Hall N R, Finan P J, al-Jaberi T. et al . Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent.  Predictor of survival but not local recurrence? Dis Colon Rectum. 1998;  41 979-983
    Search in Google Scholar
  • 28 MERCURY Study Group . Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study.  BMJ. 2006;  333 779
    Search in Google Scholar
  • 29 Marone P, de Bellis M, Avallone A. et al . Accuracy of endoscopic ultrasound in staging and restaging patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation.  Clin Res Hepatol Gastroenterol. 2011;  35 666-670
    Search in Google Scholar
  • 30 Rau B, Hunerbein M, Barth C. et al . Accuracy of endorectal ultrasound after preoperative radiochemotherapy in locally advanced rectal cancer.  Surg Endosc. 1999;  13 980-984
    Search in Google Scholar
  • 31 Novell F, Pascual S, Viella P. et al . Endorectal ultrasonography in the follow-up of rectal cancer. Is it a better way to detect early local recurrence?.  Int J Colorectal Dis. 1997;  12 78-81
    Search in Google Scholar
  • 32 Lohnert M S, Doniec J M, Henne-Bruns D. Effectiveness of endoluminal sonography in the identification of occult local rectal cancer recurrences.  Dis Colon Rectum. 2000;  43 483-491
    Search in Google Scholar
  • 33 Mascagni D, Corbellini L, Urciuoli P. et al . Endoluminal ultrasound for early detection of local recurrence of rectal cancer.  Br J Surg. 1989;  76 1176-1180
    Search in Google Scholar
  • 34 Schwartz D A, Wiersema M J, Dudiak K M. et al . A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas.  Gastroenterology. 2001;  121 1064-1072
    Search in Google Scholar
  • 35 Spradlin N M, Wise P E, Herline A J. et al . A randomized prospective trial of endoscopic ultrasound to guide combination medical and surgical treatment for Crohn’s perianal fistulas.  Am J Gastroenterol. 2008;  103 2527-2535
    Search in Google Scholar
  • 36 Yang J, Abdel-Wahab M, Ribeiro A. EUS-guided fiducial placement before targeted radiation therapy for prostate cancer.  Gastrointest Endosc. 2009;  70 579-583
    Search in Google Scholar
  • 37 Dobben A C, Terra M P, Slors J F. et al . External anal sphincter defects in patients with fecal incontinence: comparison of endoanal MR imaging and endoanal US.  Radiology. 2007;  242 463-471
    Search in Google Scholar
  • 38 Delpy R, Barthet M, Gasmi M. et al . Value of endorectal ultrasonography for diagnosing rectovaginal septal endometriosis infiltrating the rectum.  Endoscopy. 2005;  37 357-361
    Search in Google Scholar

Dr. med. Christian Jürgensen

Klinik für Gastroenterologie, Hepatologie und Endokrinologie
Charité Universitätsmedizin

Charitéplatz 1
10117 Berlin

Email: Christian.Juergensen@charite.de