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15.07.2020 | Originalien

Serratierte Kolonpolypen

verfasst von: Prof. Dr. med. W. Sterlacci, Prof. Dr. med. M. Vieth

Erschienen in: Journal für Gastroenterologische und Hepatologische Erkrankungen | Ausgabe 3/2020

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Zusammenfassung

Die Adenom-Karzinom-Sequenz im Kolon gilt zwar auch noch für nichtpolypoide Läsionen, ist jedoch um die serratierten Läsionen ergänzt worden. Serratierte Läsionen lassen sich unterteilen in die Gruppe der zumeist harmlosen, im linken Hemikolon vorkommenden hyperplastischen Polypen, die im distalen Kolon bei älteren Patienten vorkommenden traditionellen serratierten Adenome und die Entität der sessilen serratierten Läsionen vor allem im rechten Hemikolon. Der Polypen- und der Adenombegriff sind im Zusammenhang mit diesen Läsionen falsch, da zumeist lediglich eine flache schleimbedeckte Erhabenheit vorliegt, ohne dass zytologisch eine Neoplasie nachgewiesen werden kann. Dies bedeutet nichts anderes, als dass der von einigen gebrauchte Polypenbegriff nicht angebracht und darüber hinaus auch der Begriff des Adenoms in diesem Zusammenhang nicht gerechtfertigt ist. Vielmehr handelt es sich um strukturelle Veränderungen mit einem bis dato noch nicht ganz klaren Entartungsrisiko. Die sessilen serratierten Läsionen machen >10 % aller Kolonläsionen aus, sollen für 50 % der sog. Intervallkarzinome verantwortlich sein und können relativ schnell maligne transformieren. Laut den S3-Leitlinien der DGVS wird die komplette Abtragung empfohlen. Leider besteht in Bezug auf die diagnostische Sicherheit noch erheblicher Nachholbedarf bei vielen Gastroenterologen und Pathologen. Für die Pathologen gilt es, möglichst auf internationaler Ebene Konsensuskonferenzen zu halten, um klinische Fragen, wie die Häufigkeit der Entartung zu beantworten und prädiktive Faktoren zu finden.
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Metadaten
Titel
Serratierte Kolonpolypen
verfasst von
Prof. Dr. med. W. Sterlacci
Prof. Dr. med. M. Vieth
Publikationsdatum
15.07.2020
Verlag
Springer Vienna
Erschienen in
Journal für Gastroenterologische und Hepatologische Erkrankungen / Ausgabe 3/2020
Print ISSN: 1728-6263
Elektronische ISSN: 1728-6271
DOI
https://doi.org/10.1007/s41971-020-00077-3

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