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Gastroenterologie up2date 2012; 8(1): 45-57
DOI: 10.1055/s-0031-1291730
Endoskopie/Gastrointestinale Radiologie/Sonografie

© Georg Thieme Verlag KG Stuttgart · New York

Rektale Endosonografie

Stellenwert und praktische Anwendung in der GastroenterologieChristian  Jürgensen
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Publication History

Publication Date:
14 March 2012 (online)

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Updated by:

Rektale Endosonografie – Stellenwert in der GastroenterologieGastroenterologie up2date 2017; 13(02): 123-134
DOI: 10.1055/s-0043-110596

Kernaussagen

Rektumkarzinom

  • Die rektale Endosonografie ist entsprechend der deutschen S3-Richtlinie (Evidenzstärke 2b, Empfehlungsgrad A, starker Konsens) obligat im Rahmen des präoperativen Stagings des Rektumkarzinoms.

  • Sie ermöglicht eine Differenzierung auch von frühen Tumorstadien und erlaubt, einen Lymphknotenbefall durch Feinnadelpunktion zu sichern.

  • Die konkurrierende MRT kann frühe Tumorstadien schlechter differenzieren, stellt aber die insbesondere bei fortgeschrittenen Tumoren wichtige mesorektale Faszie dar.

  • Die Beurteilung einer Lymphknotenbeteiligung gelingt durch beide Methoden nicht befriedigend.

  • Die Endosonografie kann in Kombination mit der EUS-gestützten Feinnadelpunktion Rezidive sichern, wird aber nicht routinemäßig zur Nachsorge empfohlen.

Fisteln und Abszesse

  • Perianale Fisteln und Abszesse, z. B. bei Morbus Crohn, lassen sich endosonografisch mit hoher Sensitivität nachweisen, wodurch auch das therapeutische Vorgehen gesteuert werden kann.

  • Auch EUS-gesteuerte diagnostische Punktionen und Therapie von Abszessen in Form einer EUS-gesteuerten transrektalen oder alternativ transvaginalen Drainage sind möglich.

Weitere Indikationen

  • Darüber hinaus kommt die Endosonografie für den Nachweis von internen und externen Sphinkterdefekten und zur Beurteilung rektumnaher Endometrioseherde zum Einsatz.

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Dr. med. Christian Jürgensen

Klinik für Gastroenterologie, Hepatologie und Endokrinologie
Charité Universitätsmedizin

Charitéplatz 1
10117 Berlin

Email: Christian.Juergensen@charite.de

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