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Genderaspekte in der gastrointestinalen Endoskopie

Gender-specific aspects in gastrointestinal endoscopy

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Der Gastroenterologe Aims and scope

Zusammenfassung

Genderaspekte in der flexiblen Endoskopie sind analog zu den bekannten geschlechtsspezifischen Unterschieden in der Viszeralmedizin einzuordnen. Sie sind weniger begründet durch Unterschiede im Hinblick auf Gensignaturen, Sexualhormone und Immunsystem, sondern vor allem durch anatomische Unterschiede von Abdomen und kleinem Becken. Zur Thematik geschlechtsspezifischer Unterschiede in der gastrointestinalen Endoskopie liegen derzeit nur sehr wenige Daten vor. Zumeist stammen sie aus kleineren unkontrollierten Fallserien. Die größte Evidenz liegt zum Thema Koloskopie vor. Hier ist seit vielen Jahren belegt, dass insbesondere schlanke Frauen einen technisch erhöhten Schwierigkeitsgrad mit erhöhter Abbruchrate aufweisen. Mittelbar mit der Prozedur in Verbindung zu setzen, sind sedierungsassoziierte Unterschiede. Hier scheint es aufgrund veränderter Metabolisierungsprozesse zu unterschiedlichen Sedierungstiefen und Aufwachphasen bei der Anwendung von Propofol zu kommen. Das erhöhte Pankreatitisrisiko für jüngere Frauen nach endoskopischer retrograder Cholangiopankreatikographie (ERPC) ist inzwischen klar belegt. Bei der Ösophagogastroduodenoskopie (ÖGD) und der Enteroskopie zeigten sich in kleineren Serien keine Unterschiede in technischem Erfolg und Outcome. Zusammenfassend befindet sich die Evaluation geschlechtsspezifischer Unterschiede in der Endoskopie noch in der Anfangsphase. Gleichwohl sollten diese bei der Planung prospektiv-randomisierter Endoskopiestudien berücksichtigt werden.

Abstract

Gender-specific aspects in flexible endoscopy constitute an upcoming field of research in visceral medicine. They are not only based on differences in gene signatures, sex hormones and immunogenicity but moreover related to anatomic differences of the abdomen and small pelvis. To date, there is only minor evidence mostly derived from smaller endoscopic studies focusing on the topic. Large-scale studies are only available for gender differences in colonoscopy. It is well known that particularly slim female patients have a significant higher risk of more difficult and incomplete procedures. Regarding sedation there is evidence that women awaken faster after propofol-based sedation than men. This might be due to differences in metabolization. The risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is clearly higher for younger women; however an evidence-based explanation is still lacking. There are no published data showing gender differences for procedures like esophagogastroduodenoscopy (EGD) and enteroscopy. In conclusion, the analysis and evaluation of gender and sex differences in flexible endoscopy is at its early beginnings. However, gender aspects should be integrated when planning and rolling-out prospective randomized clinical trials in endoscopy.

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Authors and Affiliations

  1. Medizinische Klinik II, Klinikum Hanau, Leimenstr. 20, 63450, Hanau, Deutschland

    A. Eickhoff

  2. Medizinische Klinik C, Klinikum Ludwigshafen, Ludwigshafen, Deutschland

    R. Jakobs

  3. Innere Medizin II, St. Elisabethen-Krankenhaus Frankfurt, Frankfurt, Deutschland

    A. Riphaus

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  1. A. Eickhoff
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Correspondence to A. Eickhoff.

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Interessenkonflikt

A. Eickhoff, R. Jakobs und A. Riphaus geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Müller-Schilling, Regensburg

A. Riphaus, Frankfurt am Main

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Eickhoff, A., Jakobs, R. & Riphaus, A. Genderaspekte in der gastrointestinalen Endoskopie. Gastroenterologe 14, 91–95 (2019). https://doi.org/10.1007/s11377-019-0321-x

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  • DOI: https://doi.org/10.1007/s11377-019-0321-x

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