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Management von Kolonpolypen – von diagnostischen Entwicklungen bis zu Resektionstechniken

Management of colorectal polyps: from diagnostic developments to resection techniques

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Zusammenfassung

Der Effekt der Darmkrebsvorsorge durch die Screeningkoloskopie korreliert eng mit der sog. Adenomdetektionsrate, die der Häufigkeit, mit der Polypen/Adenome bei der Vorsorge erkannt und dann auch entfernt werden, entspricht. Die Detektion umfasst dabei das Auffinden und Entdecken relevanter Polypen und Adenome und idealerweise die sichere Differenzierung der erkannten Läsion (gutartig, bösartig, irrelevant), um unmittelbar während der Untersuchung sofort und mit hoher diagnostischer Sicherheit eine Therapie, meist die endoskopische Resektion der Läsion, durchzuführen. Die endoskopische Bildgebung hat nicht zuletzt durch die Entwicklung der High-definition(HD)-Endoskop- und 4K-Kamerasysteme sowie der Chromoendoskopie etc. in den letzten Jahrzehnten hier einen Quantensprung erzielt. Aktuell bereichert zusätzlich die neue Modalität des „deep learning“ und der künstlichen Intelligenz das Feld. Therapeutisch bestehen heute Möglichkeit zur endoskopisch sicheren Resektion von Polypen und Adenomen jedweder Größe und Konfiguration unter Einsatz verschiedener Techniken mit variabler Invasivität. Entscheidend für die Therapieallokation ist neben der Morbidität und Komplikationsrate des Verfahrens jedoch immer die Prognose des Patienten.

Abstract

The effect of colorectal cancer screening by means of screening colonoscopy correlates closely with the adenoma detection rate, which refers to the frequency with which polyps/adenomas are detected and then removed during screening. Detection comprises the identification and localization of relevant polyps and adenomas and, ideally, the reliable differentiation of the detected lesion (benign, malignant, irrelevant) in order to immediately perform treatment—usually the endoscopic resection of the lesion, directly during the examination and with high diagnostic certainty. Endoscopic imaging has achieved a quantum leap in this field, not least due to the development of high-definition (HD) endoscopes and 4K camera systems, as well as chromoendoscopy in recent decades. Currently, the new modality of “deep learning” and artificial intelligence is also enriching the field. Therapeutically, there are now possibilities for the safe endoscopic resection of polyps and adenomas of any size and configuration using a number of techniques of varying invasiveness. However, in addition to the procedureʼs morbidity and complication rate, patient prognosis is always the decisive factor when selecting this treatment.

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Authors and Affiliations

  1. Medizinische Klinik II, Klinikum Hanau, Leimenstr. 20, 63450, Hanau, Deutschland

    F. Straulino &  A. Eickhoff

  2. Medizinische Klinik, Gastroenterologie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    A. Meining

Authors
  1. F. Straulino
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  2. A. Eickhoff
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  3. A. Meining
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Correspondence to A. Eickhoff.

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Interessenkonflikt

F. Straulino, A. Eickhoff und A. Meining geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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R. Jakobs, Ludwigshafen

F. Kolligs, Berlin

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Straulino, F., Eickhoff, A. & Meining, A. Management von Kolonpolypen – von diagnostischen Entwicklungen bis zu Resektionstechniken. Gastroenterologe 15, 282–289 (2020). https://doi.org/10.1007/s11377-020-00456-5

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