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Endoskopie zur Früherkennung und Therapie kolorektaler Neoplasien

Endoscopic diagnosis and therapy of colorectal neoplasia

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Zusammenfassung

Die Früherkennung kolorektaler Neoplasien durch die Koloskopie ist in den letzten Jahren durch eine Reihe technischer Entwicklungen deutlich verbessert worden. Insbesondere die Weiterentwicklung der Videoendoskope mit der Möglichkeit einer höheren Auflösung (HDTV) sowie einer Vergrößerungsfunktion (Zoom) erleichtern das Erkennen von Schleimhautläsionen. Durch den Einsatz einer Schleimhautfärbung (Chromoendoskopie) oder auch des „narrow band imaging“ (NBI) können neoplastische von nichtneoplastischen Läsionen relativ sicher voneinander unterschieden werden. Therapeutisch werden heute T1-Karzinome endoskopisch abgetragen, wobei derzeit von den meisten Untersuchern als maximal erlaubte Eindringtiefe die obere Submukosa (sm1) gilt, bei tieferer Infiltration steigt die lymphogene Metastasierungsrate an. Die endoskopische Abtragung kann entweder als endoskopische Mukosaresektion (EMR) oder in zunehmenden Maße als endoskopische submuköse Dissektion (ESD) durchgeführt werden. Die ESD hat den Vorteil, dass das Karzinom en bloc reseziert wird und die Tumoreindringtiefe histologisch besser beurteilt werden kann. In der palliativen Situation scheint die endoskopische Einlage eines selbst expandierenden Metallstents (SEMS), insbesondere für Patienten mit nur noch kurzer Lebenszeit eine vertretbare Alternative zur Operation.

Abstract

Early detection and removal of colorectal adenomas can reduce the mortality from and incidence of colorectal cancer (CRC). The reliable detection and resection of adenomas plays an important role in CRC screening. The development of high-definition television and magnifying endoscopy has provided a new level of imaging quality for detecting neoplastic lesions. With additional chromoendoscopy and narrow band imaging, a certain discrimination between neoplastic and nonneoplastic lesions seems possible. T1 colorectal cancer resection can be performed endoscopically by endoscopic mucosa resection or endoscopic submucosal dissection (ESD). The advantage of ESD is that a precise histopathologic assessment can be made from the en bloc resected specimen. In a palliative situation, the implantation of self-expanding metal stents is an effective and safe therapy for noncurable obstructive colorectal cancer, especially in older patients with comorbidity.

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Literatur

  1. Bittinger M, Messmann H (2007) Self-expanding metal stents as nonsurgical palliative therapy for malignant colonic obstruction: time to change the standard of care? Gastrointest Endosc 66: 928–930

    Article  PubMed  Google Scholar 

  2. Chiu HM, Chang CY, Chen CC et al. (2007) A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia. Gut 56: 373–379

    Article  PubMed  Google Scholar 

  3. Fruhmorgen P, Rufle W, Kobras S et al. (2003) Endoscopic therapy of early colorectal cancer (pT1) – A prospective study. Z Gastroenterol 41: 703–710

    Article  PubMed  CAS  Google Scholar 

  4. Gono K, Obi T, Yamaguchi M et al. (2004) Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt 9: 568–577

    Article  PubMed  Google Scholar 

  5. Hosokawa K, Yoshida S (1998) Recent advances in endoscopic mucosal resection for early gastric cancer. Gan To Kagaku Ryoho 25: 476–483

    PubMed  CAS  Google Scholar 

  6. Hurlstone DP, Fujii T (2005) Practical uses of chromoendoscopy and magnification at colonoscopy. Gastrointest Endosc Clin N Am 15: 687–702

    Article  PubMed  Google Scholar 

  7. Hurlstone DP, Kiesslich R, Thomson M et al. (2008) Confocal chromoscopic endomicroscopy is superior to chromoscopy alone for the detection and characterisation of intraepithelial neoplasia in chronic ulcerative colitis. Gut 57: 196–204

    Article  PubMed  CAS  Google Scholar 

  8. Kato S, Fujii T, Koba I et al. (2001) Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: can significant lesions be distinguished? Endoscopy 33: 306–310

    Article  PubMed  CAS  Google Scholar 

  9. Kiesslich R, Goetz M, Lammersdorf K et al. (2007) Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 132: 874–882

    Article  PubMed  Google Scholar 

  10. Kiesslich R, Bergh M von, Hahn M et al. (2001) Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon. Endoscopy 33: 1001–1006

    Article  PubMed  CAS  Google Scholar 

  11. Kudo S, Rubio CA, Teixeira CR et al. (2001) Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 33: 367–373

    PubMed  CAS  Google Scholar 

  12. Kudo S, Tamura S, Nakajima T et al. (1996) Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 44: 8–14

    Article  PubMed  CAS  Google Scholar 

  13. Repici A, Fregonese D, Costamagna G et al. (2007) Ultraflex precision colonic stent placement for palliation of malignant colonic obstruction: a prospective multicenter study. Gastrointest Endosc 66: 920–927

    Article  PubMed  Google Scholar 

  14. Saito Y, Uraoka T, Matsuda T et al. (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 66: 966–973

    Article  PubMed  Google Scholar 

  15. Saitoh Y, Waxman I, West AB et al. (2001) Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology 120: 1657–1665

    Article  PubMed  CAS  Google Scholar 

  16. Sebastian S, Johnston S, Geoghegan T et al. (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99: 2051–2057

    Article  PubMed  Google Scholar 

  17. Su MY, Ho YP, Chen PC et al. (2004) Magnifying endoscopy with indigo carmine contrast for differential diagnosis of neoplastic and nonneoplastic colonic polyps. Dig Dis Sci 49: 1123–1127

    Article  PubMed  Google Scholar 

  18. Tamegai Y, Saito Y, Masaki N et al. (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 39: 418–422

    Article  PubMed  CAS  Google Scholar 

  19. Tischendorf JJ, Wasmuth HE, Koch A et al. (2007) Value of magnifying chromoendoscopy and narrow band imaging (NBI) in classifying colorectal polyps: a prospective controlled study. Endoscopy 39: 1092–1096

    Article  PubMed  CAS  Google Scholar 

  20. Uno Y, Munakata A (1994) The non-lifting sign of invasive colon cancer. Gastrointest Endosc 40: 485–489

    Article  PubMed  CAS  Google Scholar 

  21. Winawer SJ, Zauber AG, Ho MN et al. (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329: 1977–1981

    Article  PubMed  CAS  Google Scholar 

  22. Yamamoto S, Watanabe M, Hasegawa H et al. (2004) The risk of lymph node metastasis in T1 colorectal carcinoma. Hepatogastroenterology 51: 998–1000

    PubMed  Google Scholar 

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  1. St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland

    H. Schrader

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  1. H. Schrader
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Schrader, H. Endoskopie zur Früherkennung und Therapie kolorektaler Neoplasien. Gastroenterologe 3, 106–111 (2008). https://doi.org/10.1007/s11377-008-0174-1

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  • DOI: https://doi.org/10.1007/s11377-008-0174-1

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