Endoskopie bei chronisch entzündlichen Darmerkrankungen: Neues und Bewährtes

Studiendaten zu chronisch entzündlichen Darmerkrankungen (CED) zeigen, dass das Erreichen einer endoskopischen Remission einer rein klinischen Symptomkontrolle bezüglich des Verlaufs und der Prognose überlegen ist. In diesem Übersichtsartikel wird der Stellenwert der Endoskopie für den Verlauf der CED dargestellt.

Abstract

Inflammatory bowel diseases with the 2 main forms – ulcerative colitis and Crohn’s disease – are chronic relapsing diseases of the gastrointestinal tract in which dysregulation of the intestinal immune system against commensal components of the microbiome leads to perpetuated intestinal inflammation based on a genetic predisposition. While in the past symptom control was the focus of therapy, more recent data show that achieving endoscopic remission is superior to sole clinical symptom control for the further course and prognosis of the diseases. In this review article, we will present the significance of endoscopy for inflammatory bowel diseases, describe established scoring systems for endoscopic graduation of inflammatory activity and, last but not least, also present and review new endoscopic developments.

Kernaussagen

• Das Erreichen einer endoskopischen Remission ist das langfristige Therapieziel in der Behandlung von Patienten mit Colitis ulcerosa und Morbus Crohn, da diese mit einer verbesserten Langzeitprognose und einem komplikationsärmeren Verlauf beider Erkrankungen assoziiert ist.

• Der MES und der UCEIS sind die gängigsten endoskopischen Scores zur Beurteilung der endoskopischen Entzündungsaktivität bei Colitis ulcerosa.

• Der SES-CD und der Rutgeerts-Score (nach erfolgter Ileozökal-Resektion) sind die gängigsten endoskopischen Scores zur Beurteilung der endoskopischen Entzündungsaktivität bei Morbus Crohn.

• Patienten mit Colitis ulcerosa und Colitis Crohn besitzen ein erhöhtes Risiko, an einem kolorektalen Karzinom zu erkranken, und sollten in endoskopische Überwachungsprogramme eingeschlossen werden.

• Neue endoskopische Mikroskopie-Systeme wie die Endozytoskopie oder die konfokale Laser-Endomikroskopie ermöglichen eine präzise feingewebliche Bildgebung während der laufenden Untersuchungen – und teilweise auch eine funktionelle Beurteilung der Darmbarriere, mit prognostischer Relevanz.

Schlüsselwörter

Darmerkrankungen - chronisch entzündlich - Morbus Crohn - Colitis ulcerosa - Koloskopie - Endoskopie - Endozytoskopie - konfokale Laserendomikroskopie

Keywords

inflammatory bowel diseases - Crohn’s disease - ulcerative Colitis - colonoscopy - endoscopy - endocytoscopy - confocal laser endomicroscopy

Publication History

Article published online:
31 March 2025

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