Die mittlere gastrointestinale Blutung - Eine diagnostische und therapeutische Herausforderung

Seit der Einführung der Kapselendoskopie und wenig später der Doppelballonenteroskopie ist der Dünndarm nicht länger eine „Black box” in der endoskopischen Diagnostik. Insbesondere bei Patienten mit mittlerer gastrointestinaler Blutung haben die beiden Verfahren die Diagnostik revolutioniert. Weitere endoskopische Methoden in der Diagnostik einer mittleren gastrointestinalen Blutung sind die Push-Enteroskopie und die intraoperative Enteroskopie - Verfahren mit jeweils unterschiedlichen Techniken, die wiederum verschiedene Vor- und Nachteile bedingen. So scheint die Kapselendoskopie zum Beispiel für diagnostische Zwecke gut geeignet zu sein, insbesondere, wenn der Dünndarm in seiner gesamten Länge eingesehen werden muss. Ein großer Vorteil der Doppelballonenteroskopie dagegen ist, dass neben der Diagnostik gleich die Möglichkeit zum therapeutischen Eingriff besteht.

The small bowel ceased to be a „black box” in endoscopy diagnostics when capsule endoscopy and shortly thereafter double-balloon endoscopy were introduced. These two procedures revolutionised diagnostics especially in patients suffering from obscure gastrointestinal bleeding. Push enteroscopy and intraoperative endoscopy are further diagnostic methods in obscure gastrointestinal bleeding. Each of these methods is based on a different technique with different pros and cons. For example, capsule endoscopy appears well suited as a diagnostic procedure especially if the small bowel must be visible in its entire length. On the other hand, it is a great advantage of double-balloon endoscopy that it enables immediate therapeutic action besides diagnosing.

Key words

obscure gastrointestinal bleeding - capsule endoscopy - double-balloon enteroscopy - push enteroscopy - intraoperative endoscopy

Literatur

• 1 Adler DG, Knipschield M, Gostout C.. A prospective comparison of capsule endoscopy and push enteroscopy in patients with GI bleeding of obscure origin.  Gastrointest Endosc. 2004;  59 492-498
• 2 Ben Soussan E, Antonietti M, Herve S. et al. . Diagnostic yield and therapeutic implications of capsule endoscopy in obscure gastrointestinal bleeding.  Gastroenterol Clin Biol. 2004;  28 1068-1073
• 3 Carlo JT, Demarco D, Smith BA. et al. . The utility of capsule endoscopy and its role for diagnosing pathology in the gastrointestinal tract.  Am J Surg. 2006;  190 886-890
• 4 Chao CC, Ng YT Jao, Mo LR.. Capsule endoscopy for gastrointestinal bleeding with an obscure etiology.  J Formos Med Assoc. 2005;  104 659-665
• 5 Costamagna G, Shah SK, Riccioni ME. et al. . A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease.  Gastroenterology. 2002;  123 999-1005
• 6 Damian U, Schilling D, Hartmann D. et al. . Double-balloon enteroscopy of the small bowel: Comparison with video capsule endoscopy and magnetic resonance imaging.  Gastrointest Endosc. 2006;  62
• 7 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
• 8 Di Caro S, May A, Heine DG. et al. . The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact.  Gastrointest Endosc. 2005;  62 545-550
• 9 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
• 10 Ell C, Remke S, May A. et al. . The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.  Endoscopy. 2002;  34 685-689
• 11 Enns R, Go K, Chang H, Pluta K.. Capsule endoscopy: a single-centre experience with the first 226 capsules.  Can J Gastroenterol. 2004;  18 555-558
• 12 Fireman Z, Eliakim R, Adler S, Scapa E.. Capsule endoscopy in real life: a four-centre experience of 160 consecutive patients in Israel.  Eur J Gastroenterol Hepatol. 2004;  16 927-931
• 13 Fireman Z, Frieman S.. Diagnostic yield of capsule endoscopy in obscure gastrointestinal bleeding.  Digestion. 2004;  70 201-206
• 14 Garcia-Compean D, Armenta JA, Gonzalez JA, Maldonado H.. Diagnostic utility and clinical impact of capsule endoscopy in obscure gastrointestinal bleeding. Preliminary results.  Rev Gastroenterol Mex. 2005;  70 120-128
• 15 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
• 16 Hara AK, Leighton JA, Sharma VK, Fleischer DE.. Small bowel: preliminary comparison of capsule endoscopy with barium study and CT.  Radiology. 2004;  230 260-265
• 17 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
• 18 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
• 19 Heine GDN, Hadithi M, Groenen MJM. et al. . Double-balloon enteroscopy: Indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease.  Endoscopy. 2006;  38 43-49
• 20 Iddan G, Meron G, Glukhovsky A, Swain P.. Wireless capsule endoscopy.  Nature. 2000;  405 417-426
• 21 Iddan GJ, Swain CP.. History and development of capsule endoscopy.  Gastrointest Endosc Clin N Am 2004; 14 (1). 2004;  14 1-9
• 22 Jones BH, Fleischer DE, Sharma VK. et al. . Yield of repeat wireless video capsule endoscopy in patients with obscure gastrointestinal bleeding.  Am J Gastroenterol. 2005;  100 1058-1064
• 23 Kalantzis N, Papanikolaou IS, Giannakoulopoulou E. et al. . Capsule endoscopy; the cumulative experience from its use in 193 patients with suspected small bowel disease.  Hepatogastroenterology. 2005;  52 414-419
• 24 Kitiyakara T, Selby W.. Non-small-bowel lesions detected by capsule endoscopy in patients with obscure GI bleeding.  Gastrointest Endosc. 2005;  62 234-238
• 25 Kraus K, Hollerbach S, Pox C. et al. . Diagnostik okkulter Blutungen des oberen Gastrointestinaltraktes durch die Videokapselendoskopie.  Dtsch Med Wochenschr. 2004;  129 1369-1374
• 26 Lewis BS, Swain P.. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding: Results of a pilot study.  Gastrointest Endosc. 2002;  56 349-353
• 27 Maieron A, Hubner D, Blaha B. et al. . Multicenter retrospective evaluation of capsule endoscopy in clinical routine.  Endoscopy. 2004;  36 864-868
• 28 Mata A, Bordas JM, Feu F. et al. . Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: a comparative study with push enteroscopy.  Aliment Pharmacol Ther. 2004;  20 189-194
• 29 Matsumoto T, Esaki M, Moriyama T. et al. . Comparison of capsule endoscopy and enteroscopy with the double-balloon method in patients with obscure bleeding and polyposis.  Endoscopy. 2005;  37 827-832
• 30 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
• 31 May A, Nachbar L, Schneider al. M e. Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer.  Endoscopy. 2005;  37 66-70
• 32 Mönkemüller K, Weigt J, Treiber G. et al. . Diagnostic and therapeutic impact of double-balloon enteroscopy.  Endoscopy. 2006;  1 68-73
• 33 Moreno C, Arvanitakis M, Deviere J, Van Gossum A.. Capsule endoscopy examination of patients with obscure gastrointestinal bleeding: evaluation of clinical impact.  Acta Gastroenterol Belg. 2005;  68 10-14
• 34 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
• 35 Nakamura M, Niwa Y, Ohmiya N. et al. . Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with small-bowel bleeding.  Endoscopy. 2006;  38 59-66
• 36 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
• 37 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
• 38 Peter S, Heuss LT, Beglinger C, Degen L.. Capsule endoscopy of the upper gastrointestinal tract - the need for a second endoscopy.  Digestion. 2005;  72 242-247
• 39 Rastogi A, Schoen RE, Slivka A.. Diagnostic yield and clinical outcomes of capsule endoscopy.  Gastrointest Endosc. 2004;  60 959-964
• 40 Saurin JC, Delvaux M, Gaudin JL. et al. . Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy.  Endoscopy. 2003;  35 576-584
• 41 Saurin JC, 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
• 42 Scapa E, Jacob H, Lewkowicz S. et al. . Initial experience of wireless-capsule endoscopy for evaluating occult gastrointestinal bleeding and suspected small bowel pathology.  Am J Gastroenterol. 2002;  97 2776-2779
• 43 Tang SJ, Christodoulou D, Zanati S. et al. . Wireless capsule endoscopy for obscure gastrointestinal bleeding: a single-centre, one-year experience.  Can J Gastroenterol. 2004;  18 559-565
• 44 Triester SL, Leighton JA, Leontiadis GI. 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
• 45 Van Gossum A, Hittelet A, Schmit A. et al. . A prospective comparative study of push and wireless-capsule enteroscopy in patients with obscure digestive bleeding.  Acta Gastroenterol Belg. 2003;  66 199-205
• 46 Viazis N, Papaxoinis K, Theodoropoulos I. et al. . Impact of capsule endoscopy in obscure small-bowel bleeding: defining strict diagnostic criteria for a favorable outcome.  Gastrointest Endosc. 2005;  62 717-722
• 47 Voderholzer WA, Ortner M, Rogalla P. et al. . Diagnostic yield of wireless capsule enteroscopy in comparison with computed tomography enteroclysis.  Endoscopy. 2003;  35 1009-1014
• 48 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

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