Daperno M, Sostegni R, Lavagna A, Crocellà L, Ercole E, Rigazio C, Rocca R, Pera A
Center for Inflammatory Bowel Disease, Ospedale Mauriziano Umberto I - Torino (Italy).
Eur Rev Med Pharmacol Sci. 2004 Sep-Oct;8(5):209-14.
Endoscopy is an essential tool for diagnosis, management and prognostic evaluation of inflammatory bowel disease. However dyscomfort, potential risks and costs associated to endoscopic examinations should contribute to the narrowing of indications to those cases in which the result of endoscopy is essential to determine a variation in the management strategy. Ileocolonoscopy performed by an expert endoscopist allows accurate diagnosis of Crohn's disease or ulcerative colitis in up to almost 90% of cases. Colonoscopy has a prognostic role during a severe flare of disease (the occurrence of severe endoscopic lesions have a negative prognostic value with significantly higher risk not to respond to medical treatment) both in ulcerative colitis and in Crohn's disease; moreover in Crohn's disease the evaluation of recurrent lesions at anastomosis after curative surgery has a strong prognostic role (endoscopic recurrence closely correlates with clinical/surgical recurrence) and preliminary data suggest that mucosal healing assessed with endoscopy after biologic treatments could be associated with a better prognosis. Finally colonoscopy is essential for cancer surveillance during the long-term follow-up. Furthermore there are new endoscopic techniques under evaluation in inflammatory bowel disease, like wireless capsule endoscopy or double balloon enteroscopy for the imaging of small bowel, or endoscopic ultrasound for evaluation of strictures or of perianal disease. Finally some operative techniques like balloon dilation could possibly be employed more frequently in the future in the management of Crohn's disease. Future perspectives in endoscopy for IBD are chromoendoscopy and newer endoscopic imaging techniques, possibly leading to an "in-vivo histology".
内镜检查是炎症性肠病诊断、管理和预后评估的重要工具。然而，与内镜检查相关的不适、潜在风险和费用，应促使将适应证范围缩小至那些内镜检查结果对于确定管理策略的改变至关重要的病例。由专业内镜医师进行的回结肠镜检查在近90%的病例中可准确诊断克罗恩病或溃疡性结肠炎。在溃疡性结肠炎和克罗恩病的疾病严重发作期间，结肠镜检查都具有预后作用（严重内镜病变的出现具有负面预后价值，对药物治疗无反应的风险显著更高）；此外，在克罗恩病中，根治性手术后吻合口复发病变的评估具有很强的预后作用（内镜复发与临床/手术复发密切相关），初步数据表明，生物治疗后通过内镜评估的黏膜愈合可能与更好的预后相关。最后，结肠镜检查对于长期随访期间的癌症监测至关重要。此外，炎症性肠病正在评估一些新的内镜技术，如用于小肠成像的无线胶囊内镜或双气囊小肠镜，或用于评估狭窄或肛周疾病的内镜超声。最后，一些手术技术如球囊扩张术未来可能会在克罗恩病的管理中更频繁地应用。炎症性肠病内镜检查的未来前景是染色内镜和更新的内镜成像技术，可能会带来“体内组织学”。
