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Vorsorge/Prävention

Gibt es Alternativen zur Vorsorgekoloskopie?

Screening/prevention

Alternatives to screening colonoscopy

Zusammenfassung

Die Koloskopie ist der Goldstandard für die Darmkrebsvorsorge in Deutschland. Die Invasivität der Untersuchung und eine niedrige Teilnahmerate machen alternative Methoden wünschenswert. Der biochemische FOBT ist der einzige Test mit nachgewiesener Senkung der KRK-bedingten Mortalität. Nachteil des Tests ist die mäßige Sensitivität für Karzinome und geringe Sensitivität für Adenome. Immunologische FOBT weisen eine höhere Detektionsrate für kolorektale Neoplasien auf. Beide Testverfahren können jedoch keine nicht blutenden Läsionen nachweisen. Für den Einsatz des M2-PK-Stuhltests liegen bisher keine ausreichenden Untersuchungen an asymptomatischen Studienkollektiven vor. Ein Problem scheint v. a. die geringe Spezifität des Tests zu sein. Genetische Stuhluntersuchungen sind bisher ebenfalls keine sinnvolle Alternative. Die Datenlage zur CT-Kolonographie ist widersprüchlich. Probleme stellen die mangelnde Standardisierung des Verfahrens und die Strahlenexposition dar. Untersuchungen zur medikamentösen Prävention waren vorwiegend enttäuschend. Entweder war kein protektiver Effekt nachweisbar oder die Nebenwirkungsrate überwog den möglichen protektiven Effekt.

Abstract

Colonoscopy is the gold standard for colorectal cancer screening in Germany. However, due to the invasiveness of the procedure and low attendance rates alternative screening methods are warranted. Biochemical FOBT is the only test with proven reduction of colorectal cancer mortality. The disadvantages of the test are a moderate sensitivity for colorectal cancer and low sensitivity for adenomas. Immunological FOBT show a higher detection rate for colorectal neoplasia. Both tests are only able to detect bleeding colorectal neoplasia. For the M2-PK stool test no larger studies using asymptomatic people are available. A major drawback of the test seems to be the low specificity. Genetic stool testing does not seem to be a suitable alternative screening test. The data concerning CT colonography are inconsistent. Problems of the test include inadequate standardization of the procedure and concerns about radiation exposure. Studies about medical prevention of colorectal neoplasia have been disappointing. Either no protective effect was found or the protective effect was offset by the side effects of the medication.

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Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Correspondence to Dr. C. Pox.

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Pox, C., Schmiegel, S. Vorsorge/Prävention. Gastroenterologe 3, 100–105 (2008). https://doi.org/10.1007/s11377-008-0170-5

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Schlüsselwörter

  • Vorsorgekoloskopie
  • FOBT
  • Genetische Stuhltests
  • Virtuelle Kolonographie
  • Medikamentöse Prävention

Keywords

  • Colorectal cancer screening
  • FOBT
  • Genetic stool tests
  • Virtual colonography
  • Medical prevention