Aktueller Stand der Sonografie in der Gastroenterologie - Darm und oberer Gastrointestinaltrakt Teil 2

 

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Zusammenfassung

Die Sonografie hat sich in der Diagnostik von Erkrankungen des Gastrointestinaltraktes (GIT) neben Endoskopie und radiologischer Bildgebung durchgesetzt. Besprochen wurde bereits der Einsatz in der Notfalldiagnostik (akute Appendizitis, Divertikulitis/Peridivertikulitis, Ileus, Invagination und Perforation) (vgl. Teil 1 [1]). Dem Umfang der Thematik geschuldet, bleibt es dieser Übersicht vorbehalten, den aktuellen Stand der Sonografie bei den chronisch entzündlichen Darmerkrankungen (CED), seltenen Darmentzündungen (u. a. bakterielle, pseudomembranöse, neutropene Kolitis, Darmtuberkulose), ischämischen Darmkrankheiten sowie bei Erkrankungen des oberen Gastrointestinaltraktes (Magen) darzustellen. Bei der CED sind wichtige Zusatzinformationen für Ausdehnung, Aktivität, Komplikationen (Fistel, Abszess, Stenose) und Differenzialdiagnose zu erhalten. Der Wert liegt insbesondere in der Verlaufskontrolle und ggf. „Einsparung” endoskopischer Untersuchungen. Die Bedeutung der Farb-Doppler-Sonografie zur Aktivitätsbeurteilung und Differenzierung von Stenosen wird diskutiert. Die Sonografie dient darüber hinaus als Steuermethode bei therapeutischen Interventionen zur Behandlung von Abszessen (Punktion und Drainage). Ischämische Darmerkrankungen sind mittels der Farb-Doppler- und Duplexsonografie zu diagnostizieren und ebenfalls differenzialsonografisch abzugrenzen. Der Sonografie kommt eine größere Bedeutung in der Bewertung und Verlaufsbeurteilung der chronischen Darmischämien zu. Am Magen sind Wandveränderungen und Passagestörungen auch der Sonografie zugängig. Tumoren und Ulzera und deren Komplikationen (Perforation, Penetration) sind unter günstigen Bedingungen darstellbar, ein Ausschluss ist jedoch nicht möglich.

Abstract

Ultrasound has gained acceptance in the diagnosis of diseases of the gastrointestinal tract beside the classical methods such as endoscopy and X-ray. In a previous publication we discussed the use of ultrasound in emergency diagnostics (e. g., acute appendicitis, diverticulitis/peridiverticulitis, ileus, invagination and perforation) (part 1). Because of the vast extent of this topic, in this overview we will focus on the current role of ultrasound in the detection and assessment of chronic inflammatory bowel diseases, rare forms of colitis (e. g., bacterial, pseudomembranous and neutropenic colitis as well as intestinal tuberculosis), ischaemic bowel diseases as well as diseases of the upper gastrointestinal tract. In chronic inflammatory bowel diseases, ultrasound can give important additional information such as extension, activity, complication (fistula, abscess, stenosis) and in differential diagnosis. It plays an important role in follow-up investigations and can possibly reduce the number of endoscopic examinations. There is still some debate going on about the significance of colour Doppler ultrasound in assessing the activity and differentiation of stenosis. Furthermore, ultrasound is used as a method to guide interventional therapies for abscesses (puncture and drainage). Colour Doppler ultrasound can diagnose ischaemic bowel diseases and also differentiate these from other aetiologies. Ultrasound plays a greater role in the follow-up and assessment of chronic intestinal ischaemia. In the diagnosis of stomach diseases under favourable conditions ultrasound can show changes of the stomach wall, tumours, ulcers and their complication (perforation, penetration) and disturbances of the motility. But an exlusion is not possible.

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Prof. Dr. Christoph F. Dietrich

Innere Medizin 2, Caritaskrankenhaus Bad Mergentheim

Uhlandstr. 7

97980 Bad Mergentheim

Phone: ++ 49/79 31/58 22 01

Fax: ++ 49/79 31/58 22 90

Email: christoph.dietrich@ckbm.de