Kolorektales Karzinom – was bringen neue Techniken wie virtuelle Chromoendoskopie und Endomikroskopie?

Zusammenfassung

Vorläuferläsionen des kolorektalen Karzinoms können durch die Koloskopie entdeckt und unmittelbar entfernt werden, werden jedoch in bis zu 10–20 % der Fälle übersehen. Zur Verbesserung der Vorsorge ist eine Vielzahl von technischen Neuerungen in den endoskopischen Routineeinsatz überführt worden. Von diesen wird wahrscheinlich die hochauflösende Endoskopie den größten unmittelbaren Nutzen für die verbesserte Detektion insbesondere flacher und kleiner Vorläuferläsionen des kolorektalen Karzinoms erbringen. (Virtuelle) Chromoendoskopieverfahren sind hilfreich für die genaue Charakterisierung einer Läsion sowie die Definition ihrer Grenzen vor endoskopischer Resektion. Mit der konfokalen Endomikroskopie steht erstmals eine Methode zur unmittelbaren mikroskopischen Bestätigung zur Verfügung. All diese neuen Techniken werden intensiv in klinischen Studien untersucht, um insbesondere im rechten Hemikolon die Adenomdetektionsrate weiter zu verbessern und die bereits heute gute Protektion durch die Vorsorgekoloskopie zu optimieren. 

Abstract

Colonoscopy is able to detect and resect precursor lesions of colorectal carcinomas. However, up to 10–20 % of lesions may be missed. To optimize screening colonoscopy, a multitude of novel techniques have been introduced into clinical routine. High definition endoscopy bears the highest potential for immediate clinical impact to detect small and flat precursors of colorectal carcinoma. (Virtual) chromoendoscopy is used for accurate characterization and delineation of a lesion prior to endoscopic resection. Confocal endomicroscopy is able to provide microscopic histopathology during ongoing endoscopy. These novel techniques are currently being intensively studied in clinical trials to enhance adenoma detection rate especially in the right hemicolon and to further optimize the good protection from colorectal cancer by screening colonoscopy. 

Schlüsselwörter

kolorektales Karzinom - Endomikroskopie - Narrow-Band-Imaging - hochauflösende Endoskopie

Key words

colorectal carcinoma - endomicroscopy - narrow band imaging - high definition endoscopy

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