Hot Topics in der Koloskopie – Neuerungen zur Verbesserung der Diagnose und Therapie von Neoplasien

Zusammenfassung

Verbesserte Diagnosemöglichkeiten haben in den letzten Jahren dazu geführt, dass die Detektionsrate von adenomatösen Polypen weiter gesteigert werden konnte. Entscheidend hat dazu die Etablierung von hochauflösenden Videoendoskopen beigetragen. Weitere Neuerungen, wie die Nutzung eines vergrößerten Bildausschnitts, erzielten in ersten Studien positive Ergebnisse hinsichtlich einer Steigerung der Adenomdetektionsrate. Durch die Verwendung von virtuellen Färbetechniken können kolorektale Polypen optisch charakterisiert und die pathologische Diagnose vorhergesagt werden. Eine Herausforderung stellt aber nach wie vor die Detektion von serratierten Adenomen dar. Diese Polypen kommen vermehrt im rechten Hemikolon vor, dem Ort, an dem die Rate übersehener Adenome am größten ist. Der Sorgfalt des Untersuchers kommt hier eine besondere Bedeutung zu.

Bei der Entfernung von kolorektalen Polypen stehen unterschiedliche Resektionsmethoden zur Verfügung. Ein entscheidendes Kriterium bei der Auswahl der Methode ist die Größe des Polypen. Grundsätzlich ist immer die komplette Resektion anzustreben. Die endoskopische Mukosaresektion ist dafür eine etablierte Methode welche insbesondere ab einer Polypengröße von 6 mm zum Einsatz kommt. Bei sehr großen Polypen des Rektums steht die ESD zur Verfügung, wobei der Einsatz der Methode angesichts der erhöhten Invasivität sorgsam abgewogen werden sollte. Neue Verfahren wie die endoskopische Vollwandresektion sind seit kurzem auch für das Kolon verfügbar. Relevanz und Wertigkeit der Methode werden derzeit aber noch in klinischen Forschungsprojekten geprüft.

Summary

The improved diagnostic possibilities of the past few years have led to a further increase in the detection rate of adenomatous polyps. The establishment of high-resolution video endoscopy was one decisive factor. Further new developments such as the use of larger image windows produced positive results with regard to an increase of the detection rate for adenomas in the first studies. By the use of virtual color techniques colorectal polyps can now be characterized optically and the pathological diagnosis predicted. However, the detection of serrated adenomas remains a challenge. These polyps occur more frequently in the right hemicolon, just that site for which the rate of missed adenomas is the largest. In such cases the diligence of the examiner is of particular importance.

For the removal of colorectal polyps various methods are available. A decisive criterion for the choice of method is the size of the polyps. In general, complete resection is the desired target. Endoscopic mucosal resection is the established method in such cases and is used especially for polyps larger than 6 mm in diameter. In the case of very large rectal polyps ESD is available although use of this method should be carefully assessed in view of its increased invasiveness. New procedures like endoscopic full thickness resection have recently become available for use in the colon. However, the relevance and utility of the method is still being assessed in clinical research projects.

Key words

Colorectal cancer - colonoscopy - endoscopy - adenomatous polyps - video endoscopy - detection rates - neoplasias

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