Zusammenfassung
Die makroskopische Beurteilung der Schleimhautoberfläche und die Kenntnis der Klassifikation von intestinalen Frühkarzinomen sollten zum Repertoire des endoskopierenden Arztes gehören. Durch Neuerungen in der Endoskopietechnik wird eine bessere Eingrenzung und Beurteilung pathologischer Schleimhautareale möglich, der diagnostische Gewinn in der Detektion durch Techniken wie NBI sollte jedoch nicht überschätzt werden. Verfahren wie Endozytoskopie oder Konfokale Lasermikroskopie werden in Studien evaluiert und haben durchaus das Potenzial in Zukunft möglicherweise eine Differenzierung von pathologischen Schleimhautarealen zu ermöglichen. Es ist jedoch bisher nicht möglich, dadurch die histologische Beurteilung durch den Pathologen zu ersetzen.
Abstract
The macroscopic aspect and the classification of intestinal early neoplasia should be part of every endoscopist knowledge. Modern endoscopic techniques like narrow band imaging (NBI) allow a better differentiation of pathological areas but diagnostic gain for the detection of intestinal neoplasia should not be overestimated. Endocytoscopy or confocal lasermicroscopy are evaluated in clinical studies. In the future they may have the potential to allow differentiation of pathological mucosal areas. The histological workup by a pathologist can not be replaced.
Schlüsselwörter
Frühkarzinome - Narrow-Band-Imaging - neue diagnostische Techniken
Key words
early neoplasia - narrow band imaging - new diagnostic techniques
Literatur
-
1
Rosch T.
Endoskopische Mukosa Resektion im oberen und unteren Gastrointestinaltrakt.
Dtsch Med Wochenschr.
2004;
129 Suppl 2
S126-S129
-
2
Schlemper R J, Riddell R H, Kato Y. et al .
The Vienna classification of gastrointestinal epithelial neoplasia.
Gut.
2000;
47
251-255
-
3
Schlemper R J, Hirata I, Dixon M F.
The macroscopic classification of early neoplasia of the digestive tract.
Endoscopy.
2002;
34
163-168
-
4
Jung M, Hoffman A, Kiesslich R.
Frühe Neoplasien im oberen Gastro-intestinaltrakt - wie lassen sie sich zuverlässig erkennen und differenzieren?.
Dtsch Med Wochenschr.
2003;
128 Suppl 2
S 124-S 126
-
5
Kiesslich R, Fritsch J, Holtmann M, Koehler H H, Stolte M, Kanzler S, Nafe B, Jung M, Galle P R, Neurath M F.
Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis.
Gastroenterology.
2003;
124
880-888
-
6
Gossner L, Pech O, May A, Vieth M, Stolte M, Ell C.
Comparison of methylene blue-directed biopsies and four-quadrant biopsies in the detection of high-grade intraepithelial neoplasia and early cancer in Barrett's oesophagus.
Digestive and Liver Disease.
2006;
38
724-729
-
7
Lim C H, Rotimi O, Dexter S PL, Axon A TR.
Randomized crossover study that used methylene blue or random 4-quadrant biopsy for the diagnosis of dysplasia in Barrett's esophagus.
Gastrointestinal Endoscopy.
2006;
64
195-199
-
8
Wo J M, Ray M B, Mayfield-Stokes S, Al Sabbagh G, Gebrail F, Slone S P, Wilson M A.
Comparison of methylene blue-directed biopsies and conventional biopsies in the detection of intestinal metaplasia and dysplasia in Barrett's esophagus: a preliminary study.
Gastrointest Endosc.
2001;
54
294-301
-
9
Olliver J R, Wild C P, Sahay P, Dexter S, Hardie L J.
Chromoendoscopy with methylene blue and associated DNA damage in Barrett's oesophagus.
The Lancet.
2003;
362
373-374
-
10
Guelrud M, Herrera I, Essenfeld H, Castro J.
Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett's esophagus.
Gastrointest Endosc.
2001;
53
559-565
-
11
Hoffman A, Kiesslich R, Bender A, Neurath M F, Nafe B, Herrmann G, Jung M.
Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett's esophagus: a prospective randomized trial with crossover design.
Gastrointestinal Endoscopy.
2006;
64
1-8
-
12
Kudo S, Rubio C A, Teixeira C R, Kashida H, Kogure E.
Pit pattern in colorectal neoplasia: endoscopic magnifying view.
Endoscopy.
2001;
33
367-373
-
13
Kato S, Fujii T, Koba I, Sano Y, Fu K I, Parra-Blanco A, Tajiri H, Yoshida S, Rembacken B.
Assessment of colorectal lesions using magnifying colonoscopy and mucosal dye spraying: can significant lesions be distinguished?.
Endoscopy.
2001;
33
306-310
-
14
Lee J H, Kim J W, Cho Y K, Sohn C I, Jeon W K, Kim B I, Cho E Y.
Detection of colorectal adenomas by routine chromoendoscopy with indigocarmine.
The American Journal of Gastroenterology.
2003;
98
1284-1288
-
15
Kara M A, Ennahachi M, Fockens P, ten Kate F JW, Bergman J JGH.
Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett's esophagus by using narrow band imaging.
Gastrointestinal Endoscopy.
2006;
64
155-166
-
16
Yoshida T, Inoue H, Usui S, Satodate H, Fukami N, Kudo S e.
Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions.
Gastrointestinal Endoscopy.
2004;
59
288-295
-
17
Hamamoto Y, Endo T, Nosho K, Arimura Y, Sato M, Imai K.
Usefulness of narrow-band imaging endoscopy for diagnosis of Barrett's esophagus.
J Gastroenterol.
2004;
39
14-20
-
18
Kara M A, Peters F P, Rosmolen W D, Krishnadath K K, Ten Kate F J, Fockens P, Bergman J J.
High-resolution endoscopy plus chromoendoscopy or narrow-band imaging in Barrett's esophagus: a prospective randomized crossover study.
Endoscopy.
2005;
37
929-936
-
19
Machida H, Sano Y, Hamamoto Y, Muto M, Kozu T, Tajiri H, Yoshida S.
Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study.
Endoscopy.
2004;
36
1094-1098
-
20
East J E, Suzuki N, Saunders B P.
Comparison of magnified pit pattern interpretation with narrow band imaging versus chromoendoscopy for diminutive colonic polyps: a pilot study.
Gastrointest Endosc.
2007;
66
310-316
-
21
Kara M A, Peters F P, Fockens P, ten Kate F JW, Bergman J JGH.
Endoscopic video-autofluorescence imaging followed by narrow band imaging for detecting early neoplasia in Barrett's esophagus.
Gastrointestinal Endoscopy.
2006;
64
176-185
-
22
Kumagai Y, Monma K, Kawada K.
Magnifying chromoendoscopy of the esophagus: in-vivo pathological diagnosis using an endocytoscopy system.
Endoscopy.
2004;
36
590-594
-
23
Eberl T, Jechart G, Probst A, Golczyk M, Bittinger M, Scheubel R, Arnholdt H, Knuechel R, Messmann H.
Can an endocytoscope system (ECS) predict histology in neoplastic lesions?.
Endoscopy.
2007;
39
497-501
-
24
Pohl H, Koch M, Khalifa A, Papanikolaou I S, Scheiner K, Wiedenmann B, Rosch T.
Evaluation of endocytoscopy in the surveillance of patients with Barrett's esophagus.
Endoscopy.
2007;
39
492-496
-
25
Inoue H, Sasajima K, Kaga M. et al .
Endoscopic in vivo evaluation of tissue atypia in the esophagus using a newly designed integrated endocytoscope: a pilot trial.
Endoscopy.
2006;
38
891-895
-
26
Kiesslich R, Burg J, Vieth M, Gnaendiger J, Enders M, Delaney P, Polglase A, McLaren W, Janell D, Thomas S, Nafe B, Galle P R, Neurath M F.
Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo.
Gastroenterology.
2004;
127
706-713
-
27
Meining A, Schwendy S, Becker V, Schmid R M, Prinz C.
In vivo histopathology of lymphocytic colitis.
Gastrointest Endosc.
2007;
66
398-399
1 Erstautor: Prof. Dr. Helmut Messmann
Dr. med. S. K. Gölder
Klinikum Augsburg · III. Medizinische Klinik
Stenglinstraße 2
86156 Augsburg
Phone: 08 21 / 4 00 23 51
Fax: 08 21 / 4 00 33 31
Email: Stefan.Goelder@klinikum-augsburg.de
