Der Internist

, Volume 55, Issue 9, pp 1026–1038

Zufallsbefunde in Gastroskopie und Koloskopie

Schwerpunkt
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Zusammenfassung

Bei vielen spezifischen und unspezifischen gastrointestinalen Beschwerden spielt die endoskopische Diagnostik eine wichtige Rolle. Gastroskopie und Koloskopie sind leicht verfügbare und risikoarme diagnostische und interventionelle Verfahren. Die technische Weiterentwicklung der gastrointestinalen Endoskopie hat zu einer Verbesserung von Diagnostik und Therapie geführt. Neben den häufigen und erwarteten Befunden können sich Zufallsbefunde zeigen. Bei den Zufallsbefunden kann man seltene Erkrankungen von unerwarteten Diagnosen unterscheiden. Die seltenen Diagnosen bedürfen in der Regel einer individualisierten Therapie. Unerwartete Diagnosen können während (nicht richtig erkannt) oder nach einer Endoskopie auftreten (übersehen oder neu aufgetreten). Diese Übersicht beschäftigt sich mit der Frage, wie unerwartete Diagnosen minimiert und Zufallsbefunde diagnostiziert und therapiert werden.

Schlüsselwörter

Submukosale Tumoren Biopsie Intervallkarzinome Magenkarzinome Angiodysplasie 

Incidental findings in gastroscopy and colonoscopy

Abstract

For many specific and nonspecific gastrointestinal symptoms, endoscopic diagnostic procedures play an important role. Gastroscopy and colonoscopy are easily available diagnostic and interventional procedures with low risk. The technical development of gastrointestinal endoscopy has led to an improvement in diagnostics and therapy. In addition to frequent and expected findings, incidental findings may occur. The incidental findings can distinguish rare diseases of unexpected diagnoses. Rare diagnoses usually require an individualized therapy. Unexpected diagnoses can take place during (not properly detected) or after an endoscopy (overlooked or newly appeared) occur. This overview deals with the question of how to minimize unexpected diagnoses and how to diagnose and treat incidental findings.

Keywords

Submucosal neoplasms Biopsy Interval cancers Stomach neoplasms Angiodysplasia 

Literatur

  1. 1.
    o A (1999) American Gastroenterological Association medical position statement on management of oropharyngeal dysphagia. Gastroenterology 116:452–454CrossRefGoogle Scholar
  2. 2.
    Ballantyne KC, Morris DL, Jones JA et al (1987) Accuracy of identification of early gastric cancer. Br J Surg 74:618–619PubMedCrossRefGoogle Scholar
  3. 3.
    Barclay RL, Vicari JJ, Doughty AS et al (2006) Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 355:2533–2541Google Scholar
  4. 4.
    Brady PG, Nord HJ, Connar RG (1988) Granular cell tumor of the esophagus: natural history, diagnosis, and therapy. Dig Dis Sci 33:1329–1333PubMedCrossRefGoogle Scholar
  5. 5.
    Brenner H, Altenhofen L, Hoffmeister M (2010) Eight years of colonoscopic bowel cancer screening in Germany: initial findings and projections. Dtsch Arztebl Int 107:753–759PubMedCentralPubMedGoogle Scholar
  6. 6.
    Dietrich CF (2008) Endosonographie: Lehrbuch und Atlas des endoskopischen Ultraschalls. Thieme, StuttgartGoogle Scholar
  7. 7.
    Dignass A, Preiss JC, Aust DE et al (2011) Updated German guideline on diagnosis and treatment of ulcerative colitis, 2011. Z Gastroenterol 49:1276–1341Google Scholar
  8. 8.
    Evrard S, Le Moine O, Hassid S et al (2003) Zenker’s diverticulum: a new endoscopic treatment with a soft diverticuloscope. Gastrointest Endosc 58:116–120PubMedGoogle Scholar
  9. 9.
    Zenker FA (1877) Krankheiten des Oesophagus. In: von Ziemssen H (Hrsg) Handbuch der spezielen Pathologie und Therapie. LeipzigGoogle Scholar
  10. 10.
    Fekete F, Vonns C (1992) Surgical management of esophageal thoracic diverticula. Hepatogastroenterology 39:97–99PubMedGoogle Scholar
  11. 11.
    Foutch PG, Rex DK, Lieberman DA (1995) Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol 90:564–567PubMedGoogle Scholar
  12. 12.
    Gershwind ME, Chiat H, Addei KA et al (1978) Granular cell tumors of the esophagus. Gastrointest Radiol 2:327–330PubMedCrossRefGoogle Scholar
  13. 13.
    Gralnek IM, Siersema PD, Halpern Z et al (2014) Standard forward-viewing colonoscopy versus full-spectrum endoscopy: an international, multicentre, randomised, tandem colonoscopy trial. Lancet Oncol 15:353–360PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Hashiba K, Paula AL de, Silva JG da et al (1999) Endoscopic treatment of Zenker’s diverticulum. Gastrointest Endosc 49:93–97PubMedCrossRefGoogle Scholar
  15. 15.
    Hochter W, Weingart J, Kuhner W et al (1985) Angiodysplasia in the colon and rectum. Endoscopic morphology, localisation and frequency. Endoscopy 17:182–185PubMedCrossRefGoogle Scholar
  16. 16.
    Hundahl SA, Phillips JL, Menck HR (2000) The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: fifth edition American Joint Committee on cancer staging, proximal disease, and the „different disease“ hypothesis. Cancer 88:921–932PubMedCrossRefGoogle Scholar
  17. 17.
    Kaminski MF, Regula J, Kraszewska E et al (2010) Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 362:1795–1803Google Scholar
  18. 18.
    Kato M, Kaise M, Yonezawa J et al (2010) Magnifying endoscopy with narrow-band imaging achieves superior accuracy in the differential diagnosis of superficial gastric lesions identified with white-light endoscopy: a prospective study. Gastrointest Endosc 72:523–529PubMedCrossRefGoogle Scholar
  19. 19.
    Kiesslich R, Fritsch J, Holtmann M et al (2003) Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 124:880–888PubMedCrossRefGoogle Scholar
  20. 20.
    Knapp AB, Ladetsky L (2005) Endoscopic retrieval of a small bowel enteroscopy capsule lodged in a Zenker’s diverticulum. Clin Gastroenterol Hepatol 3:xxxivPubMedCrossRefGoogle Scholar
  21. 21.
    Konowitz PM, Biller HF (1989) Diverticulopexy and cricopharyngeal myotomy: treatment for the high-risk patient with a pharyngoesophageal (Zenker’s) diverticulum. Otolaryngol Head Neck Surg 100:146–153PubMedGoogle Scholar
  22. 22.
    Kudo S, Hirota S, Nakajima T et al (1994) Colorectal tumours and pit pattern. J Clin Pathol 47:880–885Google Scholar
  23. 23.
    Clercq CM le, Sanduleanu S (2014) Interval colorectal cancers: what and why. Curr Gastroenterol Rep 16:375PubMedCrossRefGoogle Scholar
  24. 24.
    Lerut T, Van Raemdonck D, Guelinckx P et al (1990) Pharyngo-oesophageal diverticulum (Zenker’s). Clinical, therapeutic and morphological aspects. Acta Gastroenterol Belg 53:330–337PubMedGoogle Scholar
  25. 25.
    Li HY, Dai J, Xue HB et al (2012) Application of magnifying endoscopy with narrow-band imaging in diagnosing gastric lesions: a prospective study. Gastrointest Endosc 76:1124–1132PubMedCrossRefGoogle Scholar
  26. 26.
    Li WB, Zuo XL, Li CQ et al (2011) Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions. Gut 60:299–306PubMedCrossRefGoogle Scholar
  27. 27.
    Magro F, Langner C, Driessen A et al (2013) European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis 7:827–851Google Scholar
  28. 28.
    Marolleau F, Baert F, Mertens V et al (2008) Abrikossoff cell tumor of the oesophagus: a case report and review of the literature. Acta Clin Belg 63:273–276PubMedGoogle Scholar
  29. 29.
    Moehler M, Al-Batran SE, Andus T et al (2011) German S3-guideline „diagnosis and treatment of esophagogastric cancer“. Z Gastroenterol 49:461–531Google Scholar
  30. 30.
    Mulder CJ, Costamagna G, Sakai P (2001) Zenker’s diverticulum: treatment using a flexible endoscope. Endoscopy 33:991–997PubMedGoogle Scholar
  31. 31.
    Nishihara R, Wu K, Lochhead P et al (2013) Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 369:1095–1105Google Scholar
  32. 32.
    Okada K, Fujisaki J, Yoshida T et al (2012) Long-term outcomes of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Endoscopy 44:122–127PubMedCrossRefGoogle Scholar
  33. 33.
    Orlowska J, Pachlewski J, Gugulski A et al (1993) A conservative approach to granular cell tumors of the esophagus: four case reports and literature review. Am J Gastroenterol 88:311–315PubMedGoogle Scholar
  34. 34.
    Pickhardt PJ, Choi JR, Hwang I et al (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349:2191–2200Google Scholar
  35. 35.
    Rabenstein T, May A, Gossner L et al (2008) Invisible gastric carcinoma detected by random biopsy: long-term results after photodynamic therapy. Endoscopy 40:899–904PubMedCrossRefGoogle Scholar
  36. 36.
    Robertson DJ, Greenberg ER, Beach M et al (2005) Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 129:34–41PubMedCrossRefGoogle Scholar
  37. 37.
    Robertson DJ, Lieberman DA, Winawer SJ et al (2014) Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut 63:949–956PubMedCrossRefGoogle Scholar
  38. 38.
    Schmit A, Van Gossum A (1998) Proposal for an endoscopic classification of digestive angiodysplasias for therapeutic trials. The European club of enteroscopy. Gastrointest Endosc 48:659PubMedCrossRefGoogle Scholar
  39. 39.
    Shpak B, Halpern Z, Kiesslich R et al (2013) A novel balloon-colonoscope for increased polyp detection rate – intermediate results of a randomized tandem study. United European Gastroenterol JGoogle Scholar
  40. 40.
    Siddiq MA, Sood S, Strachan D (2001) Pharyngeal pouch (Zenker’s diverticulum). Postgrad Med J 77:506–511CrossRefGoogle Scholar
  41. 41.
    Soetikno R, Kaltenbach T, Yeh R et al (2005) Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 23:4490–4498Google Scholar
  42. 42.
    Stefansson K, Wollmann RL (1982) S-100 protein in granular cell tumors (granular cell myoblastomas). Cancer 49:1834–1838PubMedCrossRefGoogle Scholar
  43. 43.
    Subramanian V, Mannath J, Ragunath K et al (2011) Meta-analysis: the diagnostic yield of chromoendoscopy for detecting dysplasia in patients with colonic inflammatory bowel disease. Aliment Pharmacol Ther 33:304–312PubMedCrossRefGoogle Scholar
  44. 44.
    Overbeek JJ van (1994) Meditation on the pathogenesis of hypopharyngeal (Zenker’s) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol 103:178–185PubMedGoogle Scholar
  45. 45.
    Vargo JJ (2004) Clinical applications of the argon plasma coagulator. Gastrointest Endosc 59:81–88PubMedCrossRefGoogle Scholar
  46. 46.
    Witterick IJ, Gullane PJ, Yeung E (1995) Outcome analysis of Zenker’s diverticulectomy and cricopharyngeal myotomy. Head Neck 17:382–388PubMedCrossRefGoogle Scholar
  47. 47.
    Wroblewski LE, Peek RM Jr, Wilson KT (2010) Helicobacter pylori and gastric cancer: factors that modulate disease risk. Clin Microbiol Rev 23:713–739PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Medizinische KlinikSt. Marienkrankenhaus FrankfurtFrankfurtDeutschland
  2. 2.Praxis für Innere Medizin und GastroenterologieFrankfurtDeutschland

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