Diagnostische Endosonografie 2013 – Bewährtes, Probleme und Neues

Zusammenfassung

Die ersten Versuche, flexible Endoskopie und Ultraschall in einer Methode zusammenzuführen, wurden 1978 unternommen. 35 Jahre später hat sich der endoskopische Ultraschall (EUS) zu einer faszinierenden interdisziplinären diagnostischen und interventionellen Methode auf hohem technologischem Niveau entwickelt. Die Anzahl endosonografischer Publikationen nimmt deutlich zu, in einem Jahreszeitraum wurden mehr als 700 wissenschaftliche Arbeiten zum EUS veröffentlicht. Darüber hinaus hat die wissenschaftliche und methodische Qualität der endosonografischen Literatur im letzten Jahrzehnt substanziell zugenommen. Der EUS ist heute als ein entscheidender Bestandteil der modernen klinischen Praxis akzeptiert. Gegründet auf überzeugende wissenschaftliche Evidenz hat die Methode ihren Platz in den Leitlinien medizinischer Fachgesellschaften gefunden. Jüngere Fortschritte der EUS-Technologie wie der kontrastverstärkte EUS (CE-EUS) und die Real-Time-Elastografie (RTE) haben das Potenzial, die diagnostische Genauigkeit des EUS für die Differenzialdiagnose von gastrointestinalen und Pankreasläsionen und für das Staging gastrointestinaler und pulmonaler Malignome weiter zu verbessern. Auf der Grundlage einer systematischen Analyse der aktuellen EUS-Literatur werden die wichtigsten Fragestellungen und Entwicklungen des diagnostischen EUS und der EUS-gestützten Feinnadelaspiration (EUS-FNA) diskutiert.

Abstract

First attempts to combine flexible endoscopy and ultrasound within one method have been initiated in 1978. 35 years later endoscopic ultrasound (EUS) has developed into a fascinating interdisciplinary diagnostic and interventional tool. A progressively increasing number of scientific papers in the field of EUS has been published – more than 700 in one year. Moreover, the scientific and methodical quality of EUS related publications has improved substantially in the last decade. EUS is accepted as an implement of modern clinical practice. Based on convincing scientific levels of evidence the method has been included in guidelines of several medical societies. Recent advances in EUS technology, such as contrast enhanced endoscopic ultrasound (CE-EUS) and real-time elastography (RTE) show potential to even improve further the accuracy of EUS for the differential diagnosis of pancreatic and gastrointestinal lesions and for the staging of gastrointestinal and pulmonary malignancies. Based on a systematic analysis of recent publications the most important issues and developments in diagnostic EUS and EUS-guided fine-needle aspiration (EUS-FNA) are discussed.

Schlüsselwörter

endoskopischer Ultraschall - EUS-FNA - Elastografie - kontrastverstärkter EUS

Key words

endoscopic ultrasound - EUS-FNA - Elastography - contrast-enhanced EUS

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