Kolorektales Karzinom – was bringen neue Techniken wie virtuelle Chromoendoskopie und Endomikroskopie?

Zusammenfassung

Vorläuferläsionen des kolorektalen Karzinoms können durch die Koloskopie entdeckt und unmittelbar entfernt werden, werden jedoch in bis zu 10–20 % der Fälle übersehen. Zur Verbesserung der Vorsorge ist eine Vielzahl von technischen Neuerungen in den endoskopischen Routineeinsatz überführt worden. Von diesen wird wahrscheinlich die hochauflösende Endoskopie den größten unmittelbaren Nutzen für die verbesserte Detektion insbesondere flacher und kleiner Vorläuferläsionen des kolorektalen Karzinoms erbringen. (Virtuelle) Chromoendoskopieverfahren sind hilfreich für die genaue Charakterisierung einer Läsion sowie die Definition ihrer Grenzen vor endoskopischer Resektion. Mit der konfokalen Endomikroskopie steht erstmals eine Methode zur unmittelbaren mikroskopischen Bestätigung zur Verfügung. All diese neuen Techniken werden intensiv in klinischen Studien untersucht, um insbesondere im rechten Hemikolon die Adenomdetektionsrate weiter zu verbessern und die bereits heute gute Protektion durch die Vorsorgekoloskopie zu optimieren. 

Abstract

Colonoscopy is able to detect and resect precursor lesions of colorectal carcinomas. However, up to 10–20 % of lesions may be missed. To optimize screening colonoscopy, a multitude of novel techniques have been introduced into clinical routine. High definition endoscopy bears the highest potential for immediate clinical impact to detect small and flat precursors of colorectal carcinoma. (Virtual) chromoendoscopy is used for accurate characterization and delineation of a lesion prior to endoscopic resection. Confocal endomicroscopy is able to provide microscopic histopathology during ongoing endoscopy. These novel techniques are currently being intensively studied in clinical trials to enhance adenoma detection rate especially in the right hemicolon and to further optimize the good protection from colorectal cancer by screening colonoscopy. 

kolorektales Karzinom - Endomikroskopie - Narrow-Band-Imaging - hochauflösende Endoskopie

colorectal carcinoma - endomicroscopy - narrow band imaging - high definition endoscopy

Literatur

• 1 Brenner H, Altenhofen L, Hoffmeister M. Eight years of colonoscopic bowel cancer screening in Germany: initial findings and projections.  Dtsch Arztebl Int. 2010;  107 753-759
• 2 Winawer S J, Zauber A G, Ho M N et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.  N Engl J Med. 1993;  329 1977-1981
• 3 Brenner H, Hoffmeister M, Arndt V et al. Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study.  J Natl Cancer Inst. 2010;  102 89-95
• 4 Singh H, Nugent Z, Demers A A et al. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer.  Gastroenterology. 2010;  139 1128-1137
• 5 Rex D K, Cutler C S, Lemmel G T et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.  Gastroenterology. 1997;  112 24-28
• 6 le Clerq C, Rondagh E, Riedl R et al. Interval colorectal cancers frequently have subtle macroscopic appearance: a 10 year-experience in an academic center. Chicago, USA; DDW, AGA Plenary Session 2011
• 7 Rex D K, Helbig C C. High yields of small and flat adenomas with high-definition colonoscopes using either white light or narrow band imaging.  Gastroenterology. 2007;  133 42-47
• 8 Dekker E, East J E. Does advanced endoscopic imaging increase the efficacy of surveillance colonoscopy?.  Endoscopy. 2010;  42 866-869
• 9 East J E, Stavrindis M, Thomas-Gibson S et al. A comparative study of standard vs. high definition colonoscopy for adenoma and hyperplastic polyp detection with optimized withdrawal technique.  Aliment Pharmacol Ther. 2008;  28 768-776
• 10 Buchner A M, Shahid M W, Heckman M G et al. High-definition colonoscopy detects colorectal polyps at a higher rate than standard white-light colonoscopy.  Clin Gastroenterol Hepatol. 2010;  8 364-370
• 11 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
• 12 Pohl J, Schneider A, Vogell H et al. Pancolonic chromoendoscopy with indigo carmine versus standard colonoscopy for detection of neoplastic lesions: a randomised two-centre trial.  Gut. 2011;  60 485-490
• 13 East J E, Suzuki N, Stavrinidis M et al. Narrow band imaging for colonoscopic surveillance in hereditary nonpolyposis colorectal cancer.  Gut. 2008;  57 65-70
• 14 Adler A, Aschenbeck J, Yenerim T et al. Narrow-band versus white-light high definition television endoscopic imaging for screening colonoscopy: a prospective randomized trial.  Gastroenterology. 2009;  136 410-416
• 15 Adler A, Pohl H, Papanikolaou I S et al. A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect?.  Gut. 2008;  57 59-64
• 16 Pohl J, Lotterer E, Balzer C et al. Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: a randomised multicentre trial.  Gut. 2009;  58 73-78
• 17 van den Broek F J, 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
• 18 Hoffman A, Kagel C, Goetz M et al. Recognition and characterization of small colonic neoplasia with high-definition colonoscopy using i-Scan is as precise as chromoendoscopy.  Dig Liver Dis. 2010;  42 45-50
• 19 Pohl J, Nguyen-Tat M, Pech O et al. Computed virtual chromoendoscopy for classification of small colorectal lesions: a prospective comparative study.  Am J Gastroenterol. 2008;  103 562-569
• 20 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
• 21 Kiesslich R, Goetz M, Vieth M et al. Technology insight: confocal laser endoscopy for in vivo diagnosis of colorectal cancer.  Nat Clin Pract Oncol. 2007;  4 480-490
• 22 Meining A, Frimberger E, Becker V et al. Detection of cholangiocarcinoma in vivo using miniprobe-based confocal fluorescence microscopy.  Clin Gastroenterol Hepatol. 2008;  6 1057-1060
• 23 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
• 24 van den Broek F J, van Es J A, van Eeden S et al. Pilot study of probe-based confocal laser endomicroscopy during colonoscopic surveillance of patients with longstanding ulcerative colitis.  Endoscopy. 2011;  43 116-122
• 25 Hsiung P L, 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
• 26 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
• 27 Foersch S, Kiesslich R, Waldner M J et al. Molecular imaging of VEGF in gastrointestinal cancer in vivo using confocal laser endomicroscopy.  Gut. 2010;  59 1046-1055