Mittlere gastrointestinale Blutung – die Endoskopie bringt Licht ins Dunkel

Zusammenfassung

Die mittlere gastrointestinale Blutung (MGI) ist als eine Blutung definiert, deren Blutungsquelle im Dünndarm lokalisiert ist, und stellt die häufigste Indikation zur Dünndarmendoskopie dar. Die intraoperative Enteroskopie galt über Jahrzehnte als Goldstandard. Mit Einführung der Dünndarmendoskopietechniken spielen diese heutzutage die zentrale Rolle, während die intraoperative Enteroskopie ein Reserveverfahren für selektionierte Patienten geworden ist. Aktuell stehen neben der rein diagnostischen Kapselendoskopie 5 nichtchirurgische flexible Enteroskopietechniken zur Verfügung. In Deutschland und Europa werden hauptsächlich die ballonassistierten Enteroskopietechniken (Doppelballon- und Singleballonenteroskopie) eingesetzt. Die Doppelballonenteroskopie (DBE) wurde als erste flexible Enteroskopietechnik eingeführt und hat sich weltweit etabliert. Für die DBE stehen die meisten Studienergebnisse zur Verfügung und sie ist die Technik mit der höchsten Rate an kompletten Enteroskopien. Dennoch sind technische Weiterentwicklungen, welche die Dünndarmendoskopie schneller und einfacher machen, wünschenswert. Bei Patienten mit chronischer MGI oder problematischen Patienten empfiehlt sich die Kapselendoskopie als Screeningverfahren. Bei der akuten MGI ist der flexiblen Enteroskopie aufgrund der hohen diagnostischen Ausbeute und der endoskopischen Therapiemöglichkeit der Vorzug zu geben. In problematischen Fällen oder wenn endoskopisch kein Erfolg zu erzielen ist, haben diagnostisch die CT-Angiografie und therapeutisch die konventionelle Angiografie mit Embolisation ihren Stellenwert.

Abstract

Mid-gastrointestinal bleeding is defined as a bleeding of the small bowel and is the most common indication for small bowel endoscopy. Intraoperative enteroscopy has been regarded as gold standard for a long time. With the introduction of different endoscopy techniques, they play now the central role, whereas intraoperative enteroscopy has become a reserve method for selected patients. Actually, there are, beside capsule endoscopy, five non-surgical, flexible enteroscopy techniques available. In Germany and Europe balloon-assisted enteroscopy (double balloon and single balloon enteroscopy) is mainly used. Double balloon enteroscopy (DBE) is the “oldest” flexible enteroscopy technique and has become established throughout the world for diagnostic and therapeutic examinations of the small bowel. The majority of the studies have been performed with DBE and it provides the highest rate of complete enteroscopy. Nevertheless, technical improvements to make enteroscopy easier and faster are still required. In patients with chronic MGI or problematic situations capsule endoscopy is an ideal screening option. In case of acute MGI the flexible enteroscopy techniques should be preferred because of the high diagnostic yield combined with the possibility of endoscopic therapeutic interventions. In difficult cases with unsuccessful enteroscopy, CT angiography and conventional angiography with the option of embolisation had proved their value.

Schlüsselwörter

mittlere gastrointestinale Blutung - Enteroskopie - Dünndarmendoskopie - Kapselendoskopie - Doppelballonenteroskopie - intraoperative Enteroskopie

Key words

mid-gastrointestinal bleeding - enteroscopy - small bowel endoscopy - capsule endoscopy - double balloon enteroscopy - intraoperative enteroscopy

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