Mittlere Gastrointestinale Blutung - modernes endoskopisches Management

Zusammenfassung

In den letzten Jahren hat sich das endoskopische Management von Dünndarmblutungen verändert. Die Kapselendoskopie erlaubt eine komplette, nicht-invasive Untersuchung der gesamten Dünndarm-Mukosa mit hoher diagnostischer Ausbeute. Die Befunde können die weitere Therapie entscheidend beeinflussen. In den meisten Fällen ist eine endoskopische Behandlung der Blutungsquellen im Dünndarm möglich. Die Doppelballon-Enteroskopie ermöglicht es erstmals, Blutungsquellen im gesamten Dünndarm endoskopisch ohne Operation zu erreichen und zu therapieren. Hierzu steht das gesamte Spektrum von Injektions-, Koagulations- und Klippverfahren zur Verfügung. Die Komplikationsrate ist dabei sehr gering. Für proximal gelegene Läsionen bleibt die Push-Enteroskopie eine Alternative. Eine intraoperative Enteroskopie wird sich in den meisten Fällen vermeiden lassen.

Abstract

During the past years, endoscopic management of small intestinal bleeding has changed tremendously. Capsule endoscopy allows a complete, non-invasive visualization of the small intestinal mucosa with a high diagnostic yield. The obtained findings can influence further management significantly. In most cases, endoscopic treatment of the small intestinal lesions is feasible. For the first time, double balloon enteroscopy provides access to the entire small intestine without need for surgery. For therapy, the entire endoscopic armamentarium is applicable, such as injection, coagulation and clipping. Complication rate is low. For proximal lesions, push enteroscopy remains an alternative. Intraoperative enteroscopy will be avoidable in most cases.

Schlüsselwörter

Dünndarmblutung - Videokapselendoskopie - Doppelballon-Enteroskopie - intraoperative Enteroskopie - Push-Enteroskopie

Key words

small intestinal bleeding - video capsule endoscopy - double balloon enteroscopy - intraoperative enteroscopy - push-enteroscopy

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