Download PDF
Endoskopie heute 2011; 24(4): 216-221
DOI: 10.1055/s-0031-1283841
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Endoskopie bei chronisch entzündlichen Darmerkrankungen

Endoscopy in Inflammatory Bowel Diseases
M. Goetz
I. Medizinische Klinik der Universitätsmedizin der Johannes Gutenberg-Universität Mainz
,
R. Kießlich
I. Medizinische Klinik der Universitätsmedizin der Johannes Gutenberg-Universität Mainz
› Author Affiliations
Further Information

Publication History

Publication Date:
21 December 2011 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Endoskopie ist essenziell in der Diagnostik und Therapie der chronisch entzündlichen Darmerkrankung. Ihr Stellenwert in der Entzündungsüberwachung und Therapieplanung wird wahrscheinlich in den nächsten Jahren noch zunehmen, da die mukosale Heilung sich als Ansprechparameter etabliert. Komplikationen des Morbus Crohn (z. B. Stenosen) und einer langjährigen Kolitis (z. B. intraepitheliale Neoplasien) können häufig endoskopisch erkannt und therapiert werden. Zur Überwachung bei langjähriger Kolitis hat die Chromoendoskopie einen festen Stellenwert, sie ist nach Studienlage der Weißlichtendoskopie überlegen. Sie kann für Hochrisikopatienten durch neue Techniken wie die konfokale Endomikroskopie ergänzt werden. Ob die Überwachung neue Verfahren der hochauflösenden Endoskopie oder der virtuellen Chromoendoskopie der Chromoendoskopie ebenbürtig sind, ist Gegenstand aktueller Studien.

Abstract

Gastrointestinal endoscopy is essential for the diagnosis and management of inflammatory bowel diseases. Its importance in surveillance of inflammation and therapy is expected to increase once mucosal healing is integrated into guiding therapy and response evaluation. Complications of Crohn’s disease (e. g. stenosis) and long lasting colitis (e. g. intraepithelial neoplasia) are amenable to endoscopic detection and therapy. For IBD surveillance, chromoendoscopy is superior to conventional white light endoscopy. In high risk patients, confocal laser endomicroscopy is able to complement chromoendoscopy. Current studies investigate the role of modern high definition endoscopy and virtual chromoendoscopy in comparison to chromoendoscopy.

Schlüsselwörter

chronisch entzündliche Darmerkrankung - Morbus Crohn - Colitis ulcerosa - Endoskopie - Endomikroskopie

Key words

inflammatory bowel disease - Crohn’s disease - ulcerative colitis - endoscopy - endomicroscopy
 

  • Literatur

  • 1 Pariente B, Cosnes J, Danese S et al. Development of the Crohn’s disease digestive damage score, the Lemann score. Inflamm Bowel Dis 2011; 17: 1415-1422
    CrossrefPubMedGoogle Scholar
  • 2 Odze R, Antonioli D, Peppercorn M et al. Effect of topical 5-aminosalicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis. Am J Surg Pathol 1993; 17: 869-875
    CrossrefPubMedGoogle Scholar
  • 3 D’Haens G, Geboes K, Rutgeerts P. Endoscopic and histologic healing of Crohn’s (ileo-) colitis with azathioprine. Gastrointest Endosc 1999; 50: 667-671
    CrossrefPubMedGoogle Scholar
  • 4 Cellier C, Sahmoud T, Froguel E et al. Correlations between clinical activity, endoscopic severity, and biological parameters in colonic or ileocolonic Crohn’s disease. A prospective multicentre study of 121 cases. The Groupe d’Etudes Therapeutiques des Affections Inflammatoires Digestives. Gut 1994; 35: 231-235
    CrossrefPubMedGoogle Scholar
  • 5 Rutgeerts P, Van Assche G, Vermeire S. Optimizing anti-TNF treatment in inflammatory bowel disease. Gastroenterology 2004; 126: 1593-1610
    CrossrefPubMedGoogle Scholar
  • 6 Froslie KF, Jahnsen J, Moum BA et al. Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 2007; 133: 412-422
    CrossrefPubMedGoogle Scholar
  • 7 Baert F, Moortgat L, Van Assche G et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn’s disease. Gastroenterology 2010; 138: 463-468 quiz e10-1
    CrossrefPubMedGoogle Scholar
  • 8 Moussata D, Goetz M, Gloeckner A et al. Confocal laser endomicroscopy is a new imaging modality for recognition of intramucosal bacteria in inflammatory bowel disease in vivo. Gut 2011; 60: 26-33
    CrossrefPubMedGoogle Scholar
  • 9 Kiesslich R, Goetz M, Angus EM et al. Identification of epithelial gaps in human small and large intestine by confocal endomicroscopy. Gastroenterology 2007; 133: 1769-1778
    CrossrefPubMedGoogle Scholar
  • 10 Liu JJ, Madsen KL, Boulanger P et al. Mind the gaps: confocal endomicroscopy showed increased density of small bowel epithelial gaps in inflammatory bowel disease. J Clin Gastroenterol 2011; 45: 240-245
    CrossrefPubMedGoogle Scholar
  • 11 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: 711-714
    CrossrefPubMedGoogle Scholar
  • 12 Choi PM, Nugent FW, Schoetz Jr DJ et al. Colonoscopic surveillance reduces mortality from colorectal cancer in ulcerative colitis. Gastroenterology 1993; 105: 418-424
    PubMedGoogle Scholar
  • 13 van den Broek FJ, Stokkers PC, Reitsma JB et al. Random Biopsies Taken During Colonoscopic Surveillance of Patients With Longstanding Ulcerative Colitis: Low Yield and Absence of Clinical Consequences. Am J Gastroenterol 2011; [Epub ahead of print]; DOI: 10.1038/ajg.2011.93
    PubMedGoogle Scholar
  • 14 Rutter MD, Saunders BP, Wilkinson KH et al. Most dysplasia in ulcerative colitis is visible at colonoscopy. Gastrointest Endosc 2004; 60: 334-339
    CrossrefPubMedGoogle Scholar
  • 15 Rubin DT, Rothe JA, Hetzel JT et al. Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis?. Gastrointest Endosc 2007; 65: 998-1004
    CrossrefPubMedGoogle Scholar
  • 16 Rex DK, Helbig CC. High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging. Gastroenterology 2007; 133: 42-47
    CrossrefPubMedGoogle Scholar
  • 17 Hoffman A, Sar F, Goetz M et al. High definition colonoscopy combined with i-Scan is superior in the detection of colorectal neoplasias compared with standard video colonoscopy: a prospective randomized controlled trial. Endoscopy 2010; 42: 827-833
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Dekker E, East JE. Does advanced endoscopic imaging increase the efficacy of surveillance colonoscopy?. Endoscopy 2010; 42: 866-869
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Mathy C, Schneider K, Chen YY et al. Gross versus microscopic pancolitis and the occurrence of neoplasia in ulcerative colitis. Inflamm Bowel Dis 2003; 9: 351-355
    CrossrefPubMedGoogle Scholar
  • 20 Kudo S, Tamura S, Nakajima T et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14
    CrossrefPubMedGoogle Scholar
  • 21 Kiesslich R, Neurath MF. Surveillance colonoscopy in ulcerative colitis: magnifying chromoendoscopy in the spotlight. Gut 2004; 53: 165-167
    CrossrefPubMedGoogle Scholar
  • 22 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: 880-888
    CrossrefPubMedGoogle Scholar
  • 23 Hurlstone DP, McAlindon ME, Sanders DS et al. Further validation of high-magnification chromoscopic-colonoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 2004; 126: 376-378
    CrossrefPubMedGoogle Scholar
  • 24 Rutter MD, Saunders BP, Schofield G et al. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut 2004; 53: 256-260
    CrossrefPubMedGoogle Scholar
  • 25 Hurlstone DP, Sanders DS, Lobo AJ et al. Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis: a prospective evaluation. Endoscopy 2005; 37: 1186-1192
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Kiesslich R, Goetz M, Lammersdorf K et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 2007; 132: 874-882
    CrossrefPubMedGoogle Scholar
  • 27 Marion JF, Waye JD, Present DH et al. Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial. Am J Gastroenterol 2008; 103: 2342-2349
    CrossrefPubMedGoogle Scholar
  • 28 Dignass A, Preiss JC, Aust DE et al. [Updated German guideline on diagnosis and treatment of ulcerative colitis, 2011]. Z Gastroenterol 2011; 49: 1276-1341
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Biancone L, Michetti P, Travis SJCE et al. European evidence-based Consensus on the management of ulcerative colitis: Special situations. Journal of Crohn’s and Colitis 2008; 2: 63-92
    PubMedGoogle Scholar
  • 30 Elsadani NN, East JE, Walters JR. New 2010 British Society of Gastroenterology colitis surveillance guidelines: costs and surveillance intervals. Gut 2011; 60: 282-283
    PubMedGoogle Scholar
  • 31 Itzkowitz SH, Present DH. Consensus conference: Colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis 2005; 11: 314-321
    CrossrefPubMedGoogle Scholar
  • 32 Dekker E, van den Broek FJ, Reitsma JB et al. Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy 2007; 39: 216-221
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 van den Broek FJ, Fockens P, van Eeden S et al. Narrow-band imaging versus high-definition endoscopy for the diagnosis of neoplasia in ulcerative colitis. Endoscopy 2011; 43: 108-115
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 van den Broek FJ, Fockens P, van Eeden S et al. Endoscopic tri-modal imaging for surveillance in ulcerative colitis: randomised comparison of high-resolution endoscopy and autofluorescence imaging for neoplasia detection; and evaluation of narrow-band imaging for classification of lesions. Gut 2008; 57: 1083-1089
    CrossrefPubMedGoogle Scholar
  • 35 Kuiper T, van den Broek FJ, Naber AH et al. Endoscopic trimodal imaging detects colonic neoplasia as well as standard video endoscopy. Gastroenterology 2011; 140: 1887-1894
    CrossrefPubMedGoogle Scholar
  • 36 Kiesslich R, Burg J, Vieth M et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 2004; 127: 706-713
    CrossrefPubMedGoogle Scholar
  • 37 Hsiung PL, Hardy J, Friedland S et al. Detection of colonic dysplasia in vivo using a targeted heptapeptide and confocal microendoscopy. Nat Med 2008; 14: 454-458
    CrossrefPubMedGoogle Scholar
  • 38 Goetz M, Ziebart A, Foersch S et al. In vivo molecular imaging of colorectal cancer with confocal endomicroscopy by targeting epidermal growth factor receptor. Gastroenterology 2010; 138: 435-446
    CrossrefPubMedGoogle Scholar
  • 39 Foersch S, Kiesslich R, Waldner MJ et al. Molecular imaging of VEGF in gastrointestinal cancer in vivo using confocal laser endomicroscopy. Gut 2010; 59: 1046-1055
    CrossrefPubMedGoogle Scholar
  • 40 Vieth M, Behrens H, Stolte M. Sporadic adenoma in ulcerative colitis: endoscopic resection is an adequate treatment. Gut 2006; 55: 1151-1155
    CrossrefPubMedGoogle Scholar
  • 41 Engelsgjerd M, Farraye FA, Odze RD. Polypectomy may be adequate treatment for adenoma-like dysplastic lesions in chronic ulcerative colitis. Gastroenterology 1999; 117: 1288-1294 discussion 1488-1491
    CrossrefPubMedGoogle Scholar
  • 42 Rubin PH, Friedman S, Harpaz N et al. Colonoscopic polypectomy in chronic colitis: conservative management after endoscopic resection of dysplastic polyps. Gastroenterology 1999; 117: 1295-1300
    CrossrefPubMedGoogle Scholar
  • 43 Odze RD, Farraye FA, Hecht JL et al. Long-term follow-up after polypectomy treatment for adenoma-like dysplastic lesions in ulcerative colitis. Clin Gastroenterol Hepatol 2004; 2: 534-541
    CrossrefPubMedGoogle Scholar
  • 44 Blonski W, Kundu R, Furth EF et al. High-grade dysplastic adenoma-like mass lesions are not an indication for colectomy in patients with ulcerative colitis. Scand J Gastroenterol 2008; 43: 817-820
    CrossrefPubMedGoogle Scholar
  • 45 Cosnes J, Cattan S, Blain A et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 2002; 8: 244-250
    CrossrefPubMedGoogle Scholar
  • 46 Tarrant KM, Barclay ML, Frampton CM et al. Perianal disease predicts changes in Crohn’s disease phenotype-results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol 2008; 103: 3082-3093
    CrossrefPubMedGoogle Scholar
  • 47 Ferlitsch A, Reinisch W, Puspok A et al. Safety and efficacy of endoscopic balloon dilation for treatment of Crohn’s disease strictures. Endoscopy 2006; 38: 483-487
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Thienpont C, D’Hoore A, Vermeire S et al. Long-term outcome of endoscopic dilatation in patients with Crohn’s disease is not affected by disease activity or medical therapy. Gut 2010; 59: 320-324
    CrossrefPubMedGoogle Scholar
  • 49 Grimaud JC, Munoz-Bongrand N, Siproudhis L et al. Fibrin glue is effective healing perianal fistulas in patients with Crohn’s disease. Gastroenterology 2010; 138: 2275-2281
    CrossrefPubMedGoogle Scholar
  • 50 Ng SC, Plamondon S, Gupta A et al. Prospective evaluation of anti-tumor necrosis factor therapy guided by magnetic resonance imaging for Crohn’s perineal fistulas. Am J Gastroenterol 2009; 104: 2973-2986
    CrossrefPubMedGoogle Scholar
  • 51 Asteria CR, Ficari F, Bagnoli S et al. Treatment of perianal fistulas in Crohn’s disease by local injection of antibody to TNF-alpha accounts for a favourable clinical response in selected cases: a pilot study. Scand J Gastroenterol 2006; 41: 1064-1072
    CrossrefPubMedGoogle Scholar
  • 52 Poggioli G, Laureti S, Pierangeli F et al. Local injection of Infliximab for the treatment of perianal Crohn’s disease. Dis Colon Rectum 2005; 48: 768-774
    CrossrefPubMedGoogle Scholar