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
Literatur
- 1
Benz C, Jakobs R, Riemann J F.
Does the insertion depth in push enteroscopy depend on the working length of the enteroscope?.
Endoscopy.
2002;
34
543-545
- 2
Born P, Bautz W, Zimmerhackl B, Schweigart U, Classen M.
Gastrointestinal bleeding from the papilla of Vater.
Endoscopy.
1994;
26
564
- 3
Born P, Huber W, Neuhaus H, Classen M.
Duodenalvarizenblutung.
Dtsch Med Wochenschr.
1995;
120
1241-1247
- 4
Bouhnik Y, Bitoun A, Coffin B, Moussaoui R, Oudghiri A, Rambaud J C.
Two way push videoenteroscopy in investigation of small bowel disease.
Gut.
1998;
43
280-284
- 5
Classen M.
Die Stellung der Endoskopie innerhalb der Gastroenterologie.
Internist.
1976;
17
185-189
- 6
Classen M, Frühmorgen P, Koch H, Demling L.
Fiberoptische Endoskopie von Jejunum and Ileum.
Dtsch Med Wochenschr.
1972;
97
409-411
- 7
Costamagna G, Shah S K, Riccioni M E. et al .
A prospective trial comparing small bowel radiographs and video capsule endoscopy
for suspected small bowel disease.
Gastroenterology.
2002;
123
999-1005
- 8
Delvaux M, Fassler I, Gay G.
Clinical usefulness of the endoscopic video capsule as the initial intestinal investigation
in patients with obscure digestive bleeding: validation of a diagnostic strategy based
on the patient outcome after 12 months.
Endoscopy.
2004;
36
1067-1073
- 9
Di Caro S, May A, Heine D G. et al .
The European experience with double-balloon enteroscopy: indications, methodology,
safety, and clinical impact.
Gastrointest Endosc.
2005;
62
545-550
- 10
Ell C, May A.
Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give
rise to a new medical term.
Endoscopy.
2006;
38
73-75
- 11
Ell C, May A, Nachbar L. et al .
Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results
of a prospective European multicenter study.
Endoscopy.
2005;
37
613-616
- 12
Ell C, Remke S, May A, Helou L, Henrich R, Mayer G.
The first prospective controlled trial comparing wireless capsule endoscopy with push
enteroscopy in chronic gastrointestinal bleeding.
Endoscopy.
2002;
34
685-689
- 13
Frimberger E, Hagenmüller F, Classen M.
Endostomy: a new approach to small-bowel endoscopy.
Endoscopy.
1989;
21
86-88
- 14
Gay G, Delvaux M, Fassler I.
Outcome of capsule endoscopy in determining indication and route for push-and-pull
enteroscopy.
Endoscopy.
2006;
38
49-58
- 15
Hadithi M, Heine G D, Jacobs M A, van Bodegraven A A, Mulder C J.
A prospective study comparing video capsule endoscopy with double-balloon enteroscopy
in patients with obscure gastrointestinal bleeding.
Am J Gastroenterol.
2006;
101
52-57
- 16
Hartmann D, Schilling D, Bolz G. et al .
Capsule endoscopy versus push enteroscopy in patients with occult gastrointestinal
bleeding.
Z Gastroenterol.
2003;
41
377-382
- 17
Hartmann D, Schmidt H, Bolz G. et al .
A prospective two-center study comparing wireless capsule endoscopy with intraoperative
enteroscopy in patients with obscure GI bleeding.
Gastrointest Endosc.
2005;
61
826-832
- 18
Iddan G, Meron G, Glukhovsky A, Swain P.
Wireless capsule endoscopy.
Nature.
2000;
405
417
- 19
Jakobs R, Hartmann D, Benz C. et al .
Diagnosis of obscure gastrointestinal bleeding by intra-operative enteroscopy in 81
consecutive patients.
World J Gastroenterol.
2006;
12
313-316
- 20
Junquera F, Feu F, Papo M. et al .
A multicenter, randomized, clinical trial of hormonal therapy in the prevention of
rebleeding from gastrointestinal angiodysplasia.
Gastroenterology.
2001;
121
1073-1079
- 21
Lai L H, Wong G L, Chow D K, Lau J Y, Sung J J, Leung W K.
Long-term follow-up of patients with obscure gastrointestinal bleeding after negative
capsule endoscopy.
Am J Gastroenterol.
2006;
101
1224-1228
- 22
Lo S K, Mehdizadeh S.
Therapeutic uses of double-balloon enteroscopy.
Gastrointest Endosc Clin N Am.
2006;
16
363-376
- 23
Matsumoto T, Esaki M, Moriyama T, Nakamura S, Iida M.
Comparison of capsule endoscopy and enteroscopy with the double-balloon method in
patients with obscure bleeding and polyposis.
Endoscopy.
2005;
37
827-832
- 24
May A, Nachbar L, Ell C.
Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility
and diagnostic and therapeutic yield in patients with suspected small bowel disease.
Gastrointest Endosc.
2005;
62
62-70
- 25 Messmann H, Schölmerich J. Die untere gastrointestinale Blutung. In: Classen M,
Tytgat GNJ, Lightdale CJ (Hrsg). Gastrointestionale Endoskopie. Thieme, Stuttgart,
New York 2004; 579-589
- 26
Mylonaki M, Fritscher-Ravens A, Swain P.
Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy
and colonoscopy negative gastrointestinal bleeding.
Gut.
2003;
52
1122-1126
- 27
Nakamura M, Niwa Y, Ohmiya N. et al .
Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients
with suspected small-bowel bleeding.
Endoscopy.
2006;
38
59-66
- 28
Neu B, Ell C, May A. et al .
Capsule endoscopy versus standard tests in influencing management of obscure digestive
bleeding: results from a German multicenter trial.
Am J Gastroenterol.
2005;
100
1736-1742
- 29
Nguyen N Q, Rayner C K, Schoeman M N.
Push enteroscopy alters management in a majority of patients with obscure gastrointestinal
bleeding.
J Gastroenterol Hepatol.
2005;
20
716-721
- 30
Pennazio M, Santucci R, Rondonotti E. et al .
Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy:
report of 100 consecutive cases.
Gastroenterology.
2004;
126
643-653
- 31
Pesch H J, Koch H, Classen M.
Experimentelle und histologische Untersuchungen zur Elektrokoagulation blutender Läsionen
im oberen Gastrointestinaltrakt.
Leber Magen Darm.
1973;
3
172-176
- 32
Rey J F, Gay G, Kruse A, Lambert R.
European Society of Gastrointestinal Endoscopy guideline for video capsule endoscopy.
Endoscopy.
2004;
36
656-658
- 33
Rösch T, Ell C.
Derzeitige Bewertung der Kapselendoskopie in der Diagnostik von Dünndarmerkrankungen.
Z Gastroenterol.
2004;
42
247-259
- 34
Saurin J C, Delvaux M, Vahedi K. et al .
Clinical impact of capsule endoscopy compared to push enteroscopy: 1-year follow-up
study.
Endoscopy.
2005;
37
318-323
- 35
Schepp W, Allescher H D, Madaus S. et al .
A rare source of occult gastrointestinal bleeding: jejunal filiae secondary to metastatic
lung carcinoma.
Hepatogastroenterology.
1986;
33
83-85
- 36
Shahed M, Hagenmüller F, Rösch T. et al .
A 19-year-old female with blue rubber bleb nevus syndrome. Endoscopic laser photocoagulation
and surgical resection of gastrointestinal angiomata.
Endoscopy.
1990;
22
54-56
- 37
Triester S L, Leighton J A, Leontiadis G I. et al .
A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities
in patients with obscure gastrointestinal bleeding.
Am J Gastroenterol.
2005;
100
2407-2418
- 38
Voderholzer W A, Ortner M, Rogalla P, Beinhölzl J, Lochs H.
Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography
enteroclysis.
Endoscopy.
2003;
35
1009-1014
- 39
Wong R C.
Acute GI bleeding: upper and lower, but is there a “middle kingdom”?.
Gastrointest Endosc.
2003;
58
409-412
- 40
Yamamoto H, Kita H, Sunada K. et al .
Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal
diseases.
Clin Gastroenterol Hepatol.
2004;
2
1010-1016
- 41
Yamamoto H, Yano T, Kita H, Sunada K, Ido K, Sugano K.
New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal
disorders.
Gastroenterology.
2003;
125
1556-1557
Prof. Dr. F. Hagenmüller
1. Medizinische Abteilung · Asklepios Klinik Altona
Paul-Ehrlich-Str. 1
22763 Hamburg
eMail: Friedrich.Hagenmueller@ak-altona.lbk-hh.de
