Rutter M D, Saunders B P, Schofield G, Forbes A, Price A B, Talbot I C
Wolfson Unit for Endoscopy and Department of Gastroenterology, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
Gut. 2004 Feb;53(2):256-60. doi: 10.1136/gut.2003.016386.
Colonoscopic surveillance for cancer in longstanding extensive ulcerative colitis relies heavily on non-targeted mucosal biopsies. Chromoendoscopy can aid detection of subtle mucosal abnormalities. We hypothesised that routine pancolonic indigo carmine dye spraying would improve the macroscopic detection of dysplasia and reduce the dependence on non-targeted biopsies.
One hundred patients with longstanding extensive ulcerative colitis attending for colonoscopic surveillance underwent "back to back" colonoscopies. During the first examination, visible abnormalities were biopsied, and quadrantic non-targeted biopsies were taken every 10 cm. Pancolonic indigo carmine (0.1%) was used during the second colonoscopic examination, and any additional visible abnormalities were biopsied.
Median extubation times for the first and second colonoscopies were 11 and 10 minutes, respectively. The non-targeted biopsy protocol detected no dysplasia in 2904 biopsies. Forty three mucosal abnormalities (20 patients) were detected during the pre-dye spray colonoscopy of which two (two patients) were dysplastic: both were considered to be dysplasia associated lesions/masses. A total of 114 additional abnormalities (55 patients) were detected following dye spraying, of which seven (five patients) were dysplastic: all were considered to be adenomas. There was a strong trend towards statistically increased dysplasia detection following dye spraying (p = 0.06, paired exact test). The targeted biopsy protocol detected dysplasia in significantly more patients than the non-targeted protocol (p = 0.02, paired exact test).
No dysplasia was detected in 2904 non-targeted biopsies. In comparison, a targeted biopsy protocol with pancolonic chromoendoscopy required fewer biopsies (157) yet detected nine dysplastic lesions, seven of which were only visible after indigo carmine application. Careful mucosal examination aided by pancolonic chromoendoscopy and targeted biopsies of suspicious lesions may be a more effective surveillance methodology than taking multiple non-targeted biopsies.
长期广泛溃疡性结肠炎的癌症结肠镜监测严重依赖非靶向黏膜活检。色素内镜检查有助于发现细微的黏膜异常。我们推测常规全结肠靛胭脂染料喷洒可改善发育异常的宏观检测并减少对非靶向活检的依赖。
100例因结肠镜监测前来就诊的长期广泛溃疡性结肠炎患者接受了“背靠背”结肠镜检查。在第一次检查期间，对可见异常进行活检，并每10厘米进行象限非靶向活检。在第二次结肠镜检查期间使用全结肠靛胭脂（0.1%），对任何其他可见异常进行活检。
第一次和第二次结肠镜检查的中位拔管时间分别为11分钟和10分钟。非靶向活检方案在2904次活检中未检测到发育异常。在染料喷洒前的结肠镜检查中检测到43处黏膜异常（20例患者），其中2处（2例患者）为发育异常：两者均被认为是发育异常相关病变/肿物。染料喷洒后共检测到114处额外异常（55例患者），其中7处（5例患者）为发育异常：均被认为是腺瘤。染料喷洒后发育异常检测有统计学上增加的强烈趋势（p = 0.06，配对精确检验）。靶向活检方案检测到发育异常的患者明显多于非靶向方案（p = 0.02，配对精确检验）。
2904次非靶向活检未检测到发育异常。相比之下，全结肠色素内镜检查的靶向活检方案所需活检次数较少（157次），但检测到9处发育异常病变，其中7处仅在应用靛胭脂后可见。全结肠色素内镜检查辅助仔细的黏膜检查以及对可疑病变进行靶向活检可能是一种比进行多次非靶向活检更有效的监测方法。
