Download PDF
Z Gastroenterol 2000; 38(7): 597-602
DOI: 10.1055/s-2000-7451
Übersicht
© Karl Demeter Verlag im Georg Thieme Verlag

Die diagnostische und therapeutische Enteroskopie

Aktueller StandC. Benz, J. F. Riemann
  • Medizinische Klinik C (Direktor: Prof. Dr. J. F. Riemann), Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein
Further Information

Publication History

8.9.1999

11.10.1999

Publication Date:
31 December 2000 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Push-Enteroskopie ist eine in vielen Schwerpunktkliniken mittlerweile etablierte endoskopische Untersuchungsmethode des Dünndarms. Dabei bietet dieses Verfahren gegenüber der sog. Sondenenteroskopie den Vorteil einer Interventionsmöglichkeit (z. B. Entnahme von Biopsien, Polypektomie, Blutungsstillungsverfahren), da das Push-Enteroskop über einen Arbeitskanal verfügt. Hauptindikation für die endoskopische Untersuchung des Dünndarms ist nach wie vor die Suche nach einer intestinalen Blutungsquelle nach Ausschluss häufiger Blutungsquellen im Gastrointestinaltrakt. Andere diagnostische und therapeutische Indikationen sind demgegenüber sehr viel seltener.

In dieser Übersicht werden nach einer kurzen Beschreibung des Verfahrens die aktuellen diagnostischen und therapeutischen Aspekte der Push-Enteroskopie beleuchtet und der Stellenwert des Verfahrens im Vergleich zu anderen Untersuchungsmethoden dargelegt.

(The diagnostic and therapeutic push-enteroscopy - an overview)

In many gastroenterological departments, the push-enteroscopy has become a well-established method to investigate the small bowel. Compared to the sonde-enteroscopy, this method has the advantage of offering the opportunity to intervene (e. g., taking biopsies, polypectomy, electrocoagulation) since the push-enteroscope has a working channel. The main indication for an endoscopic procedure is still the search for intestinal sources of bleeding after more frequent sources in the gastrointestinal tract have been ruled out. Other diagnostic and therapeutic indications are less frequent.

In this overview we will first describe the procedure. Then we will review the most recent diagnostic and therapeutic aspects of the push-enteroscopy and compare it to other procedures.

Schlüsselwörter

Push-Enteroskopie - intestinale Blutung - Dünndarmangiodysplasien

Key words

Push-enteroscopy - Intestinal bleeding - angio­dysplasias

Literatur

  • 1 Lewis B S, Kornbluth A, Waye J D. Small bowel tumours: Yield of of enteroscopy.  Gut. 1991;  32 763-765
    Google Scholar
  • 2 Lewis B S, Waye J D. Chronic gastrointestinal bleeding of obscure origin: Role of small bowel enteroscopy.  Gastroenterology. 1988;  94 1117-1120
    Google Scholar
  • 3 Benz C, Martin W R, Arnold J. et al . Die endoskopische Untersuchung des Dünndarms mit Push-Enteroskopie. Eine prospektive Untersuchung.  Dtsch Med Wochenschr. 1997;  122 391-395
    Google Scholar
  • 4 Schlauch D, Riemann J F. Enteroskopie - Erweiterung des diagnostischen Spektrums. Überblick und eigene Ergebnisse.  Z Gastroenterol. 1993;  31 464-467
    Google Scholar
  • 5 Hayat M, Axon ATR, O’Mahony S. Diagnostic yield and effect on clinical outcomes of push-enteroscopy in suspected small-bowel bleeding.  Endoscopy. 2000;  32 369-372
    Google Scholar
  • 6 Lala A K, Sitaram V, Perakath B. et al . Intraoperative enteroscopy in obscure gastrointestinal hemorrhage.  Hepatogastroenterology. 1998;  45 597-602
    Google Scholar
  • 7 Lau W Y. Intraoperative enteroscopy - indications and limita­tions.  Gastrointest Endosc. 1990;  36 268-271
    Google Scholar
  • 8 Lau W Y, Fan S T, Wong S A. et al . Preoperative and intraoperative localisation of gastrointestinal bleeding of obscure origin.  Gut. 1987;  28 869-877
    Google Scholar
  • 9 Zaman A, Sheppard B, Katon RM. Total peroral intraoperative enteroscopy for obscure Gl bleeding using a dedicated push ­enteroscope: Diagnostic yield and patient outcome.  Gastrointest Endosc. 1999;  50 506-510
    Google Scholar
  • 10 Lopez M J, Cooley J S, Petros J G. et al . Complete intraoperative small-bowel endoscopy in the evaluation of occult gastrointestinal bleeding using the sonde enteroscope.  Arch Surg. 1996;  131 272-277
    Google Scholar
  • 11 Classen M, Frühmorgen P, Koch H, Demling L. Enteroskopie: Fiberendoskopie von Jejunum und Ileum.  Dtsch Med Wochenschr. 1972;  97 409-411
    Google Scholar
  • 12 Berner J S, Mauer K, Lewis B S. Push and sonde enteroscopy for the diagnosis of obscure gastrointestinal bleeding.  Am J Gastroenterol. 1994;  89 2139-2142
    Google Scholar
  • 13 Hoffman J S, Cave D R, Birkett D. Intra-operative enteroscopy with a sonde intestinal fiberscope.  Gastrointest Endosc. 1994;  4 229-230
    Google Scholar
  • 14 Lewis B S, Waye J D. Total small bowel enteroscopy.  Gastrointest Endosc. 1987;  33 435-438
    Google Scholar
  • 15 Tada M, Shimizu S, Kawai K. A new transnasal sonde type fiberscope (SSIF type VII) as a pan-enteroscope.  Endoscopy. 1986;  18 121-124
    Google Scholar
  • 16 Neuhaus H. Pernasale Endoskopie des Dünndarms.  Endoskopie heute. 1989;  2 48-51
    Google Scholar
  • 17 Dykman D D, Killian S E. Initial experience with the Pentax VSB-P2900 enteroscope.  Am J Gastroenterol. 1993;  88 570-573
    Google Scholar
  • 18 Barkin J S, Chong J, Reiner D K. First-generation video enteroscope: Fourth-generation push-type small bowel enteroscopy utilizing an overtube.  Gastrointest Endosc. 1994;  4 743-747
    Google Scholar
  • 19 Barkin J S, Lewis B S, Reiner D K. et al . Diagnostic and therapeutic jejunoscopy with a new, longer enteroscope.  Gastrointest Endosc. 1992;  38 55-58
    Google Scholar
  • 20 Dabezies M A, Fisher R S, Krevsky B. Video small bowel enteroscopy: Early experience with a prototype instrument.  Gastrointest Endosc. 1991;  37 60-62
    Google Scholar
  • 21 Waye J D. Small-Bowel-Endoscopy.  Endoscopy. 1998;  3 133-140
    Google Scholar
  • 22 Waye J D. Small-Bowel-Endoscopy.  Endoscopy. 1999;  31 56-59
    Google Scholar
  • 23 Bouhnik Y, Bitoun A, Coffin B. et al . Two way push videoenteroscopy in investigation of small bowel disease.  Gut. 1998;  43 280-284
    Google Scholar
  • 24 Lewis M PN, Khoo D E, Spencer J. Value of laparotomy in the diagnosis of obscure gastrointestinal haemorrhage.  Gut. 1995;  37 187-190
    Google Scholar
  • 25 OConnel H, Martin C J. Intra-operative enteroscopy in the management of bleeding small bowel lesions.  Aust N Z J Surg. 1992;  62 394-396
    Google Scholar
  • 26 Desa L A, Ohri S K, Hutton K A. et al . Role of intraoperative enteroscopy in obscure gastrointestinal bleeding of small bowel origin.  Br J Surg. 1991;  78 192-195
    Google Scholar
  • 27 Rodriguez-Bigas M A, Penetrante R B, Herrera L. et al . Intraoperative small bowel enteroscopy in familial adenomatous and familial juvenile polyposis.  Gastrointest Endosc. 1995;  42 560-564
    Google Scholar
  • 28 Davies G R, Benson M J, Gertner D J. et al . Diagnostic and therapeutic push type enteroscopy in clinical use.  Gut. 1995;  37 346-352
    Google Scholar
  • 29 Lewis B S. Small intestinal bleeding.  Gastroenterol Clin North Am. 1994;  23 67-91
    Google Scholar
  • 30 Jacconi P, Aldi R, Ricci E. et al . Small bowel angiodysplasia: Usefulness of peroperative enteroscopy.  Ital J Gastroenterol. 1993;  25 68-71
    Google Scholar
  • 31 Lewis B S, Wenger J S, Waye J D. Small bowel enteroscopy and intraoperative enteroscopy for obscure gastrointestinal bleeding.  Am J Gastroenterol. 1991;  86 171-174
    Google Scholar
  • 32 Van Bergeijkl J D, Fockens P, Mulder C JJ. et al . Enteroscopy for unexplained iron-deficiency anemia. Take enough biopsies.  Gastrointest Endosc. 1994;  4 113-115
    Google Scholar
  • 33 Gostout C J, Schroeder K W, Burton D D. Small bowel enteroscopy: An early experience in gastrointestinal bleeding of unknown origin.  Gastrointest Endosc. 1991;  37 5-8
    Google Scholar
  • 34 Chak A, Cooper G S, Canto M I. et al . Enteroscopy for the initial evaluation of iron deficiency.  Gastrointest Endosc. 1998;  47 144-148
    Google Scholar
  • 35 Chong J, Tagle M, Barkin J S. et al . Small bowel push-type fiberoptic enteroscopy for patients with occult gastrointestinal bleeding or suspected small bowel pathology.  Am J Gastroenterol. 1994;  89 2143-2146
    Google Scholar
  • 36 Foutch P G, Sawyer R, Sanowski R A. Push-enteroscopy for diagnosis of patients with gastrointestinal bleeding of obscure origin.  Gastrointest Endosc. 1990;  36 337-341
    Google Scholar
  • 37 Zaman A, Katon R M. Push enteroscopy for obscure gastrointestinal bleeding yields a high incidence of proximal lesions within reach of a standard endoscope.  Gastrointest Endosc. 1998;  47 372-376
    Google Scholar
  • 38 Chak A, Koehler M A, Sundaram S N. et al . Diagnostic and therapeutic impact of push enteroscopy: Analysis of factors associated with positive findings.  Gastrointest Endosc. 1998;  47 18-22
    Google Scholar
  • 39 O’Mahony S, Morris A J, Straiton M. et al . Push enteroscopy in the investigation of small-intestinal disease.  QJM. 1996;  89 685-690
    Google Scholar
  • 40 Dusold R, Burke K, Carpentier W. et al . The accuracy of Technetium-99m-labeled red cell scintigraphy in localizing gastrointestinal bleeding.  Am J Gastroenterol. 1994;  89 345-348
    Google Scholar
  • 41 Nolan D J. The true yield of the small-intestinal barium study.  Endoscopy. 1997;  29 1-7
    Google Scholar
  • 42 Benz C, Martin W R, Arnold J C. et al . Ein seltener Befund und eine seltene Methode: Diagnostik eines Jejunalkarzinoms mit der Push-Enteroskopie.  Leber Magen Darm. 1999;  29 108-110
    Google Scholar
  • 43 Bozkurt T, Lux G. Transabdominelle Ultraschalldiagnostik bei entzündlichen und tumorösen Darmerkrankungen.  Dtsch Med Wochenschr. 1998;  123 128-134
    Google Scholar
  • 44 Bozkurt T, Butsch B, Schmiegelow P. et al . Sonographische Darstellung mesenchymaler Dünndarmtumoren in der Diagnostik von unklaren, gastrointestinalen Blutungen.  Ultraschall Med. 1993;  14 264-268
    Google Scholar
  • 45 Pennazio M, Arrigoni A, Risio M. et al . Clinical evaluation of push-type enteroscopy.  Endoscopy. 1995;  27 164-170
    Google Scholar
  • 46 Landi B, Tkoub M, Gaudric M. et al . Diagnostic yield of push-type enteroscopy in relation to indication.  Gut. 1998;  42 421-425
    Google Scholar
  • 47 Schmit A, Gay F, Adler M. et al . Diagnostic efficacy of push-enter­oscopy and long-term follow-up of patients with small bowel angiodysplasias.  Dig Dis Sci. 1996;  41 2348-2352
    Google Scholar
  • 48 Askin M, Lewis B S. Push enteroscopic cauterization: Long-term follow-up of 83 patients with bleeding small intestinal angiodysplasia.  Gastrointest Endosc. 1996;  43 580-583
    Google Scholar
  • 49 Morris A J, Mokhashi M, Straiton M. et al . Push enteroscopy and heater probe therapy for small bowel bleeding.  Gastrointest Endosc. 1996;  44 394-397
    Google Scholar
  • 50 Foutch P G, Sanowski R A, Kelly S. Enteroscopy: A method for detection of small bowel tumors.  Am J Gastroenterol. 1985;  8 887-890
    Google Scholar
  • 51 Morris A J, Madhok R, Sturrock R D. et al . Enteroscopic diagnosis of small bowel ulceration in patients receiving non-steroidal anti-inflammatory drugs.  Lancet. 1991;  337 520
    Google Scholar
  • 52 Morris A J, MacKenzie J F. Small-bowel enteroscopy and NSAID ulceration.  Lancet. 1991;  337 1550 (Letter)
    Google Scholar
  • 53 Morris A J. Nonsteroidal anti-inflammatory drug enteropathy.  Gastrointest Endosc Clin N Am. 1999;  9 125-133
    Google Scholar
  • 54 Barkin J S, Schonfeld W, Thomsen S. et al . Enteroscopy and small bowel biopsy - an improved technique for the diagnosis of small bowel disease.  Gastrointest Endosc. 1985;  31 215-217
    Google Scholar
  • 55 Gay G J, Delmotte J S. Enteroscopy in small intestinal inflammatory diseases.  Gastrointest Endosc Clin N Am. 1999;  9 115-123
    Google Scholar
  • 56 Perez-Cuadrado E, Macenlle  R, Iglesias J. et al . Usefulness of oral video push enteroscopy in Crohn’s disease.  Endoscopy. 1997;  29 745-747
    Google Scholar
  • 57 Schmit A, Gay F, Van Gossum A. How effective is enteroscopy?.  Acta Gastroenterol Belg. 1995;  58 201-207
    Google Scholar
  • 58 Rossini F P, Risio M, Pennazio M. Small bowel tumors and polyposis syndromes.  Gastrointest Endosc Clin N Am. 1999;  9 93-114
    Google Scholar
  • 59 Barkin J S, Ross B S. Medical therapy for chronic gastrointestinal bleeding of obscure origin.  Am J Gastroenterol. 1998;  93 1250-1254
    Google Scholar
  • 60 Benz C, Jakobs R, Spiethoff A. et al .Seltene Ursachen einer Eisenmangelanämie: Rezidivierende Blutung aus einem Karzinoid des Jejunums - Diagnostik und Therapie mittels Enteroskopie. Z Gastroenterol 1999;. 37: 725-729
    Google Scholar
  • 61 Shackel N A, Bowen D G, Selby W S. Video push enteroscopy in the investigation of small bowel disease: Defining clinical indications and outcomes.  Aust N Z J Med. 1998;  28 198-203
    Google Scholar
  • 62 Delmotte J S, Gay G J, Houcke P H. et al . Intraoperative endoscopy.  Gastrointest Endosc Clin N Am. 1999;  9 61-69
    Google Scholar
  • 63 Wilmer A, Rutgeerts P. Push enteroscopy. Technique, depth, and yield of insertion.  Gastrointest Endosc Clin N Am. 1996;  5 759-776
    Google Scholar

Anschrift für die Verfasser:

Dr. med. Claus A. Benz

Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH

Bremserstraße 79

67063 Ludwigshafen

Phone: 06 21/5 03 41 00

Fax: 06 21/5 03 41 14

Email: MedCLu@t-online.de

      >