Positionspapier der Sektion Endoskopie der DGVS zur Darmreinigung vor Koloskopie

Einleitung

Nach Angaben des Statistischen Bundesamtes verstarben im Jahr 2005 in der Bundesrepublik Deutschland 27 223 Menschen an „bösartigen Neubildungen des Dickdarms”. Das kolorektale Karzinom ist damit bei Mann und Frau die zweithäufigste tumorbedingte Todesursache. Die Koloskopie ist die Methode der Wahl zur Untersuchung des Kolons und es ist die effektivste Vorsorgeuntersuchung. Die Reduktion der Inzidenz und der Mortalität des kolorektalen Karzinoms ist sowohl für den Haemoccult-Test und inzwischen auch für die Koloskopie bei einem Polypenkollektiv (National Polyp Study) belegt [1]. Die Rate der bei der Vorsorgekoloskopie gefundenen krebsrelevanten Polypen liegt bei ca. 6 %, die der neu entdeckten Karzinome bei 1 %. Die Zahl der notwendigen Koloskopien zur Entdeckung eines fortgeschrittenen Polypen liegt in Abhängigkeit vom Geschlecht und Alter zwischen 36 und 10, sie steigt mit zunehmenden Alter und männlichem Geschlecht [2]. Die Vorsorgekoloskopie sollte nach den derzeit gültigen deutschen Leitlinien spätestens im Alter von 55 Jahren durchgeführt werden [3].

Die Detektionsrate von Adenomen und kolorektalen Karzinomen hängt entscheidend von der Qualität der Darmvorbereitung ab [4] [5] [6]. Nach einer optimalen Darmreinigung sollten nur wenig Restflüssigkeit und keine Reststuhlmengen im Kolon zurückbleiben. Eine unzureichende Darmreinigung reduziert die Beurteilbarkeit der Darmmukosa erheblich, führt zu einer verlängerten Untersuchungszeit, verbunden mit Unannehmlichkeiten für den Patienten, und ggf. auch zu einem Abbruch der Untersuchung, der eine Wiederholungsuntersuchung erforderlich macht [7]. Eine schlechte Darmvorbereitung betrifft insbesondere das Zökum und Colon ascendens. Studien der letzten Jahre haben gezeigt, dass gerade im Zökum und C. ascendens gehäuft flache Adenome zu finden sind [8] [9] [10], deren Detektion eine optimale Reinigung dieses Darmsabschnittes voraussetzt.

Ein wichtiger Faktor für eine gute Darmvorbereitung stellt die Compliance der Patienten dar, die in der Regel einfach zu handhabende kurze Vorbereitungsregime mit akzeptablem Geschmack und wenig Trinkvolumen bevorzugen.

Das vorliegende Papier soll nach Vorstellung und Diskussion der aktuellen Datenlage die Position der Sektion Endoskopie der DGVS zur Koloskopievorbereitung beschreiben.

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