Kann Peter Herbert
Bereich Endokrinologie and Diabetologie, Zentrum für Innere Medizin, Universitätsklinikum Giessen und Marburg, Standort Marburg, Fachbereich Medizin der Philipps-Universität Marburg, Marburg.
Med Klin (Munich). 2006 Jul 15;101(7):546-51. doi: 10.1007/s00063-006-1064-2.
Endoscopic ultrasound enables imaging of the pancreas with high resolution. Today, it is considered to be the best preoperative imaging procedure in insulinomas. Since the result of endoscopic ultrasound may influence surgical strategy (minimally invasive approach), it needs to be performed in all patients. Furthermore, positive endoscopic ultrasound is able to confirm the diagnosis of insulinoma, since fasting test also may have been positive due to the intake of sulfonylureas or glinides which may have been missed Patiin toxicological analysis. However, false-positive and false-negative results always have to be taken into account. Gastrinomas which are located in the pancreas are usually detected by endoscopic ultrasound, yet often missed when localized in the duodenal wall. Thus, endoscopic ultrasound is not very helpful in treatment planning here. In multiple endocrine neoplasia type 1 (MEN1), endoscopic ultrasound is by far the best method to analyze the morphology of the pancreas. Clinical consequences are difficult, since the unclear prognosis of very small neuroendocrine pancreatic tumors in MEN1 on the one hand and possible side effects of surgical treatment (perioperative complications, diabetes mellitus following pancreatic surgery) on the other hand need to be discussed.
内镜超声能够对胰腺进行高分辨率成像。如今，它被认为是胰岛素瘤术前最佳的成像检查方法。由于内镜超声的结果可能会影响手术策略（微创方法），因此所有患者都需要进行该项检查。此外，内镜超声检查结果呈阳性能够确诊胰岛素瘤，因为禁食试验也可能因摄入磺脲类或格列奈类药物而呈阳性，而这些药物在毒理学分析中可能被遗漏。然而，始终需要考虑假阳性和假阴性结果。位于胰腺的胃泌素瘤通常可通过内镜超声检测到，但当位于十二指肠壁时往往会被漏诊。因此，内镜超声在这方面的治疗规划中帮助不大。在1型多发性内分泌腺瘤病（MEN1）中，内镜超声是分析胰腺形态的最佳方法。临床决策很困难，因为一方面MEN1中非常小的神经内分泌胰腺肿瘤预后不明，另一方面手术治疗可能存在副作用（围手术期并发症、胰腺手术后糖尿病），需要对这些问题进行讨论。
