Innovative endoskopische Dünndarmdiagnostik

Kernaussagen

Methoden der Dünndarmdiagnostik

• Mittels Push-Enteroskopie können zwischen 50 und 100 cm des Dünndarms distal des Magens eingesehen werden.

• Hauptindikation zur Durchführung einer Dünndarmkapselendoskopie ist die obskure gastrointestinale Blutung.

• Eine signifikante Verbesserung der diagnostischen Ausbeute der Kapselendoskopie durch den Einsatz von Darmlavagelösungen und Prokinetika ist nicht belegt.

• Einzige absolute Kontraindikation zur Durchführung einer Kapselendoskopie ist die intestinale Stenose.

• Eine komplette Enteroskopie mittels Doppelballonenteroskopie gelingt bei 60-80 % der Patienten. Meist ist dabei eine Kombination von oralem und analem Zugangsweg erforderlich. Limitationen ergeben sich hauptsächlich durch Verwachsungen nach abdominellen Operationen.

Obskure gastrointestinale Blutung

• Angiodysplasien stellen mit 80 % die häufigste Blutungsursache dar.

• Die diagnostische Ausbeute der Kapselendoskopie beträgt etwa 60 %.

• Die Kapselendoskopie ist allen radiologischen Verfahren in der Diagnostik der chronischen obskuren Blutung signifikant überlegen.

• Bei 30-80 % der Patienten mit positiven Kapselendoskopiebefunden ergibt sich eine therapeutische Konsequenz. 70 % der therapierten Patienten zeigen eine Verbesserung des Langzeitverlaufes, gemessen an Transfusionsbedarf, Anzahl der Rezidivblutungen und Hospitalisierungsrate.

• Die akute, kreislaufrelevante obskure gastrointestinale Blutung ist keine Indikation zur Durchführung einer Dünndarmkapselendoskopie. Hier ist die klassische Angiographie neben der intraoperativen Endoskopie Methode der Wahl.

• Im Vergleich zur Kapselendoskopie weist die Doppelballonenteroskopie eine tendenziell höhere diagnostische Ausbeute auf, vorausgesetzt es erfolgt eine komplette Enteroskopie.

Morbus Crohn

• Bei etwa 20 % der Crohn-Patienten liegt ein selektiver Dünndarmbefall vor.

• Die Kapselendoskopie ist allen radiologischen Verfahren in der Detektion von mukosalen Veränderungen signifikant überlegen.

• Radiologische Verfahren wie der CT- oder MR-Sellink erlauben zusätzlich eine Darstellung von extraintestinalen Befunden, Fisteln und Abszessen.

• Dünndarmstenosen können häufig mittels Doppelballonenteroskopie effektiv therapiert werden.

Polyposis-Syndrome

• Sowohl die Kapselendoskopie als auch der MR-Sellink zeigen eine hohe Sensitivität für die Detektion von Dünndarmpolypen, wobei die Kapselendoskopie dem MR-Sellink bei der Detektion von Polypen < 15 mm überlegen ist.

• Die Doppelballonenteroskopie ermöglicht eine endoskopische Therapie von Polypen im Bereich des mittleren Dünndarms.

Dünndarmtumore und Sprue

• Dünndarmtumore gehören zu den relevanten Befunden in allen größeren Kapselendoskopiestudien.

• Etwa 60 % der detektierten Tumore sind maligne, in etwa 50 % handelt es sich um Metastasen.

• Häufigstes Leitsymptom von Dünndarmtumoren ist die gastrointestinale Blutung.

• Die Sprue wird in etwa 1 % aller Untersuchungen mittels Doppelballonenteroskopie und Kapselendoskopie als Zufallsbefund erhoben.

• In seltenen Fällen werden die Doppelballonenteroskopie und die Kapselendoskopie gezielt in der Diagnostik der therapierefraktären Sprue eingesetzt.

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