Feussner Hubertus, Becker Valentin, Bauer Margit, Kranzfelder Michael, Schirren Rebekka, Lüth Tim, Meining Alexander, Wilhelm Dirk
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
2nd Medical Department, Klinikum rechts der Isar, Technische Universität München, Germany.
Clin Exp Gastroenterol. 2014 Dec 18;8:31-42. doi: 10.2147/CEG.S46584. eCollection 2015.
Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel - for long a "white spot" for gastrointestinal endoscopy - and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early) malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings.
柔性内镜检查正日益发展成为一种治疗手段，而非单纯的诊断学科。可视化的改善使得早期病变易于检测，并使我们能够根据实际情况决定所需的治疗方案。深度小肠镜检查能够探查小肠，而小肠长期以来一直是胃肠内镜检查的“盲区”，并且还能进行直接治疗。内镜下黏膜剥离术是（早期）恶性病变肿瘤学上正确的内镜治疗的一个重大进步。尽管在技术上仍然具有挑战性，但新的操作技术和工具不断得到优化，这使得该技术越来越便利。壁缺损的闭合和止血可以得到显著改善。甚至通过腔内超声的治疗应用，人们正在探索胃肠壁以外的解剖结构。如果传统的内镜逆行胰胆管造影失败，内镜超声引导下手术不仅是一种合适的替代解决方案，而且甚至使内镜医师能够进行坏死组织切除术、脓肿引流和神经松解术。新开发的内镜方法旨在解决诸如胃食管反流病、阑尾炎和胆囊炎等以前属于外科领域的疾病。内镜/腹腔镜联合介入技术可能成为经自然腔道内镜手术的先驱，而单纯的经自然腔道内镜手术目前仍处于起步阶段。
