Elastografie: Stellenwert im Gastrointestinaltrakt

Nichtinvasive elastografische Verfahren haben in den letzten Jahren in der klinischen Praxis insbesondere in der Detektion der Leberfibrose und der Leberzirrhose, aber auch in der Einschätzung des Leberfettgehalts bei der nicht alkoholischen Fettlebererkrankung (NAFLD) an Bedeutung gewonnen. Der Artikel gibt eine Übersicht über den aktuellen Stand der Forschung und den Stellenwert der nichtinvasiven Verfahren in der Gastroenterologie.

Kernaussagen

• Verschiedene nichtinvasive elastografische Verfahren (nichtinvasive Tests, NIT) wurden zur Beurteilung des Fibrosestadiums entwickelt, die im klinischen Alltag, insbesondere in der Detektion von Leberfibrose und -zirrhose, an Bedeutung gewonnen, die klinische Praxis in der Hepatologie verändert und damit den Stellenwert der Leberbiopsie als Goldstandard in den Hintergrund gerückt haben.

• Die am besten validierte nichtinvasive Methode stellt die vibrationsgesteuerte transiente Elastografie (TE) dar, welche die Möglichkeit bietet, die Steifigkeit des Lebergewebes (Liver-Stiffness Measurement, LSM) zu bestimmen und so einen Rückschluss auf die Fibrose erlaubt.

• Neben kombinierten serologischen Fibrosemarkern kommen zunehmend auch Elastografieverfahren zum Einsatz, um Patienten mit fortgeschrittener Fibrose einer NASH (nicht alkoholische Steatohepatitis) zu erkennen.

• Der Einsatz von nichtinvasiven Tests bei Patienten mit alkoholbedingten Leberschäden ist sinnvoll und attraktiv, da eine frühzeitige Erkennung der Krankheit zu einer Verringerung des Alkoholkonsums führen und dadurch das Fortschreiten der Erkrankung unterbrechen könnte.

• Liver-Stiffness Measurement (LSM) mittels transienter Elastografie ist nach wie vor das am besten validierte Instrument zur Diagnose und zum Ausschluss einer fortgeschrittenen Fibrose und Leberzirrhose sowie zur Detektion einer portalen Hypertension.

• Die prognostische Bedeutung der transienten Elastografie ist inzwischen für zahlreiche Lebererkrankungen – chronische HBV, chronische HCV, HCV/HIV-Koinfektion, primär sklerosierende Cholangitis (PSC), primär biliäre Cholangitis (PBC), NAFLD (nicht alkoholische Fettlebererkrankung) – sowie gemischte Kollektive mit chronischen Lebererkrankungen belegt. Die Elastografie ist hierbei der Leberbiopsie überlegen und ermöglicht gerade bei Patienten mit Leberzirrhose eine weitere Risikostratifizierung.

Schlüsselwörter

transiente Elastografie - nichtinvasiver Test - nicht alkoholische Fettlebererkrankung - Leberzirrhose

Publikationsverlauf

Artikel online veröffentlicht:
12. Dezember 2022

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