Vieth M, Behrens H, Stolte M
Institut für Pathologie, Klinikum Bayreuth GmbH, Germany.
Gut. 2006 Aug;55(8):1151-5. doi: 10.1136/gut.2005.075531. Epub 2006 Jan 19.
In studies with small numbers of cases, it has been shown that endoscopic resection of adenomas in ulcerative colitis represents adequate treatment. In a larger study cohort with more prolonged follow up, we assessed the reliability of this finding.
Between 1988 and 2002, 148 consecutive patients, mainly from private gastroenterologists' practices, with ulcerative colitis were diagnosed as having an adenoma. In 60 patients, histological diagnosis was established in biopsies and in 87 patients in polypectomy specimens; one patient underwent proctocolectomy following diagnosis. The outcome of these patients was analysed after a mean follow up period of 6.0 (3.63) years.
Among 60 patients, surprisingly without endoscopic treatment, 48.3% developed ulcerative colitis associated neoplasia in the same colon segment (23.3% low grade intraepithelial neoplasia; 8.3% high grade intraepithelial neoplasia; 16.7% carcinoma). Among 87 patients undergoing polypectomy of the adenoma, follow up revealed colitis associated neoplasia in other segments of colon in 4.6% of cases.
Development of adenocarcinomas in a total of 6.7% of the overall patient group, and in 2.3% of those undergoing polypectomy, indicates that biopsy based diagnosis of an adenoma in ulcerative colitis must be considered to mandate endoscopic resection of the lesion; 40% of affected patients did not receive any form of endoscopic removal of the lesion. This shows that the most recent guidelines are not followed in a considerable number of patients with ulcerative colitis in private practice in Germany. Although polypectomy of the adenoma represents adequate therapy, further regular follow up examinations are nevertheless necessary.
在小样本病例研究中，已表明溃疡性结肠炎腺瘤的内镜切除是充分的治疗方法。在一个更大且随访时间更长的研究队列中，我们评估了这一发现的可靠性。
1988年至2002年间，148例主要来自私人胃肠病医生诊所的溃疡性结肠炎患者被诊断患有腺瘤。60例患者通过活检确立组织学诊断，87例患者通过息肉切除标本确立诊断；1例患者在诊断后接受了全结肠直肠切除术。在平均随访6.0（3.63）年后分析这些患者的结局。
在60例未接受内镜治疗的患者中，令人惊讶的是，48.3%在同一结肠段发生了溃疡性结肠炎相关肿瘤（23.3%为低级别上皮内瘤变；8.3%为高级别上皮内瘤变；16.7%为癌）。在87例行腺瘤息肉切除术的患者中，随访发现4.6%的病例在结肠其他段出现了结肠炎相关肿瘤。
在整个患者组中，共有6.7%发生腺癌，在接受息肉切除术的患者中为2.3%，这表明基于活检诊断溃疡性结肠炎腺瘤必须考虑对病变进行内镜切除；40%的受影响患者未接受任何形式的内镜下病变切除。这表明在德国私人诊所中，相当一部分溃疡性结肠炎患者未遵循最新指南。尽管腺瘤息肉切除术是充分的治疗方法，但仍需要进一步定期随访检查。
