Download PDF
Z Gastroenterol 2007; 45(4): 325-331
DOI: 10.1055/s-2007-962987
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Überwachungskoloskopie bei Colitis ulcerosain Deutschland

Surveillance Colonoscopy in Ulcerative Colitis Patients in GermanyB. Kaltz1 , B. Bokemeyer2 , J. Hoffmann3 , R. Porschen4 , G. Rogler5 , W. Schmiegel6
  • 1Deutsche Morbus Crohn/Colitis Ulcerosa Vereinigung DCCV e. V., Leverkusen
  • 2Gastroenterologische Gemeinschaftspraxis, Minden
  • 3Medizinische Klinik I, Charité Campus Benjamin Franklin, Berlin
  • 4Zentrum für Innere Medizin, Klinikum Bremen-Ost, Bremen
  • 5Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum, Regensburg
  • 6Medizinische Universitätsklinik, Knappschaftskrankenhaus, Bochum
Further Information

Publication History

Manuskript eingetroffen: 7.12.2006

Manuskript akzeptiert: 13.2.2007

Publication Date:
11 April 2007 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Berichte von Betroffenen und Ärzten haben die Vermutung entstehen lassen, dass in Deutschland Überwachungskoloskopien zur Karzinomprävention bei Colitis ulcerosa (Cu) selten leitliniengerecht vorgenommen werden. Eine Umfrage der Selbsthilfeorganisation Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung e. V. (DCCV) unter Mitgliedern, die zu den Risikogruppen mit entsprechender Ausbreitung der Colitis ulcerosa und Krankheitsdauer gehören, hat diese Vermutung für die Zahl der bei der Koloskopie genommenen Biopsien bestätigt. Nur bei 9,2 % der Risikopatienten erfolgte eine leitlinienkonforme Koloskopie und bei über 50 % der Risikopatienten wurden weniger als 10 Biopsien genommen.

Abstract

It has been assumed that cancer surveillance colonoscopy in patients with ulcerative colitis is not conducted according to the guidelines in Germany. An inquiry of the self-help organisation German Crohn’s Disease/Ulcerative Colitis Association (DCCV) among organisation members belonging to colorectal cancer risk groups confirmed that the number of biopsies taken during colonoscopy is less than that proposed by the guidelines. Only with 9.2 % of the risk group did a guideline-conformal colonoscopy take place. In more than 50 % of the cases less than 10 biopsies were taken.

Schlüsselwörter

Colitis ulcerosa - chronisch entzündliche Darmerkrankung - Koloskopie - Prävention - Kolonneoplasie

Key words

ulcerative colitis - chronic inflammatory bowel disease - colonoscopy - prevention - colon neoplasms

Literatur

  • 1 Eaden J A, Abrams K R, Mayberry J F. The risk of colorectal cancer in ulcerative colitis: a meta-analysis.  Gut. 2001;  48 (4) 526-535
    Google Scholar
  • 2 Chambers W M, Warren B F, Jewell D P. et al . Cancer surveillance in ulcerative colitis.  Br J Surg. 2005;  92 (8) 928-936
    Google Scholar
  • 3 Ekbom A, Helmick C, Zack M. et al . Ulcerative colitis and colorectal cancer. A population-based study.  N Engl J Med. 1990;  323 (18) 1228-1233
    Google Scholar
  • 4 Rubin C E, Haggitt R C, Burmer G C. et al . DNA aneuploidy in colonic biopsies predicts future development of dysplasia in ulcerative colitis.  Gastroenterology. 1992;  103 (5) 1611-1620
    Google Scholar
  • 5 Zack M M, Ekbom A, Persson P G. et al . Evaluation of surveillance programmes for colorectal cancer in ulcerative colitis patients by case-control studies: methodological considerations.  J Med Screen. 1997;  4 (3) 137-141
    Google Scholar
  • 6 Choi P M, Nugent F W, Schoetz Jr D J. et al . Colonoscopic surveillance reduces mortality from colorectal cancer in ulcerative colitis.  Gastroenterology. 1993;  105 (2) 418-424
    Google Scholar
  • 7 Connell W R, Talbot I C, Harpaz N. et al . Clinicopathological characteristics of colorectal carcinoma complicating ulcerative colitis.  Gut. 1994;  35 (10) 1419-1423
    Google Scholar
  • 8 Karlen P, Kornfeld D, Brostrom O. et al . Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control study.  Gut. 1998;  42 (5) 711-714
    Google Scholar
  • 9 Rutter M D, Saunders B P, Wilkinson K H. et al . Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis.  Gastroenterology. 2006;  130 (4) 1030-1038
    Google Scholar
  • 10 Lindberg J, Stenling R, Palmqvist R. et al . Efficiency of colorectal cancer surveillance in patients with ulcerative colitis: 26 years’ experience in a patient cohort from a defined population area.  Scand J Gastroenterol. 2005;  40 (9) 1076-1080
    Google Scholar
  • 11 Schmiegel W, Pox C, Kroesen A. Colitis ulcerosa. Karzinomprophylaxe.  Z Gastroenterol. 2004;  42 (9) 1014-1018
    Google Scholar
  • 12 Hoffmann R M, Kruis W. Chronisch-entzündliche Darmerkrankungen. Sauerbruch T, Scheurlen CH Empfehlungen der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS) für die Durchführung endoskopischer Untersuchungen, 3. Auflage Stuttgart; Demeter 2002: 135-147
    Google Scholar
  • 13 Winawer S, Fletcher R, Rex D. et al . Gastrointestinal Consortium Panel. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence.  Gastroenterology. 2003;  124 (2) 544-560
    Google Scholar
  • 14 Kornbluth A, Sachar D B. Practice Parameters Committee of the American College of Gastroenterology . Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee.  Am J Gastroenterol. 2004;  99 (7) 1371-1385
    Google Scholar
  • 15 Eaden J A, Mayberry J F. British Society for Gastroenterology; Association of Coloproctology for Great Britain and Ireland . Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease.  Gut. 2002;  51 (Suppl 5) V10-12
    Google Scholar
  • 16 New Zealand Guidelines Group (NZGG) .Surveillance and management of groups at increased risk of colorectal cancer. Wellington; Mai 2004 www. nzgg.org.nz
    Google Scholar
  • 17 Itzkowitz S H, Present D H. Crohn’s and Colitis Foundation of America Colon Cancer in IBD Study Group . Consensus conference: Colorectal cancer screening and surveillance in inflammatory bowel disease.  Inflamm Bowel Dis. 2005;  11 (3) 314-321
    Google Scholar
  • 18 Hudson B, Green J. British Society of Gastroenterology guidelines for ulcerative colitis surveillance: creating consensus or confusion?.  Gut. 2006;  55 (7) 1052-1053
    Google Scholar
  • 19 Obrador A, Ginard D, Barranco L. Review Article: Colorectal cancer surveillance in ulcerative colitis - what should we be doing?.  Aliment Pharmacol Ther. 2006;  24 (Suppl 3) 56-63
    Google Scholar
  • 20 Eaden J A, Ward B A, Mayberry J F. How gastroenterologists screen for colonic cancer in ulcerative colitis: an analysis of performance.  Gastrointest Endosc. 2000;  51 (2) 123-128
    Google Scholar
  • 21 Gearry R B, Wakeman C J, Barclay M L. et al . Surveillance for dysplasia in patients with inflammatory bowel disease: a national survey of colonoscopic practice in New Zealand.  Dis Colon Rectum. 2004;  47 (3) 314-322
    Google Scholar
  • 22 Bernstein C N, Weinstein W M, Levine D S. et al . Physicians’ perceptions of dysplasia and approaches to surveillance colonoscopy in ulcerative colitis.  Am J Gastroenterol. 1995;  90 (12) 2106-2114
    Google Scholar
  • 23 Timmer A, Bauer A, Bokhof B. et al . Sexual Function in Men with IBD - a survey with controls.  DDW. 2006, ID# W1046; 
    Google Scholar
  • 24 Raspe H, Muche-Borowski C. Versorgungsnetze für CED-Kranke - KN Chronisch entzündliche Darmerkrankungen (KN-CED). BMBF Von der Forschung in die Versorgung - Kompetenznetze in der Medizin Berlin; BMBF 2006: 37-38
    Google Scholar
  • 25 Delco F, Sonnenberg A. A decision analysis of surveillance for colorectal cancer in ulcerative colitis.  Gut. 2000;  46 (4) 500-506
    Google Scholar
  • 26 Provenzale D, Gray R N. Colorectal cancer screening and treatment: review of outcomes research.  J Natl Cancer Inst Monogr. 2004;  33 45-55
    Google Scholar
  • 27 Kiesslich R, Fritsch J, Holtmann M. et al . Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis.  Gastroenterology. 2003;  124 (4) 880-888
    Google Scholar
  • 28 Rutter M D, Saunders B P, Schofield G. et al . Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis.  Gut. 2004;  53 (2) 256-260
    Google Scholar
  • 29 Tanaka S, Oka S, Hirata M. et al . Pit pattern diagnosis for colorectal Neoplasia using narrow band imaging magnification.  Digestive Endoscopy. 2006;  18 (Suppl 1) S52-S56
    Google Scholar
  • 30 Messmann H, Endlicher E, Freunek G. et al . Fluorescence endoscopy for the detection of low and high grade dysplasia in ulcerative colitis using systemic or local 5-aminolaevulinic acid sensitisation.  Gut. 2003;  52 (7) 1003-1007
    Google Scholar
  • 31 Ochsenkuhn T, Tillack C, Stepp H. et al . Low frequency of colorectal dysplasia in patients with long-standing inflammatory bowel disease colitis: detection by fluorescence endoscopy.  Endoscopy. 2006;  38 (5) 477-482
    Google Scholar
  • 32 Kiesslich R, Hoffman A, Goetz M. et al . In vivo diagnosis of collagenous colitis by confocal endomicroscopy.  Gut. 2006;  55 (4) 591-592
    Google Scholar
  • 33 Holzmann K, Weis-Klemm M, Klump B. et al . Comparison of flow cytometry and histology with mutational screening for p53 and Ki-ras mutations in surveillance of patients with long-standing ulcerative colitis.  Scand J Gastroenterol. 2001;  36 (12) 1320-1326
    Google Scholar
  • 34 Rex D K, Petrini J L, Baron T H. et al . ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for colonoscopy.  Am J Gastroenterol. 2006;  101 (4) 873-885
    Google Scholar
  • 35 Rutter M D, Saunders B P, Wilkinson K H. et al . Intangible Costs and Benefits of Ulcerative Colitis Surveillance: A Patient Survey.  Dis Colon Rectum. 2006;  49 (8) 1177-1183
    Google Scholar

Birgit Kaltz

stv. Vorsitzende, DCCV

Paracelsusstr. 15

51375 Leverkusen

Phone: ++49/2 14/87 60 80

Fax: ++49/2 14/8 76 08 88

Email: bkaltz@dccv.de

      >