Hurlstone D P, George R, Brown S
Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
Biotech Histochem. 2007 Apr;82(2):57-71. doi: 10.1080/10520290701259340.
Since the adenoma-carcinoma sequence was first proposed by Morson in the 1970s, it has become widely accepted that detection and subsequent removal of polypoid adenomas from the colon reduces the incidence of colorectal cancer. These adenomas are relatively easy to detect by conventional colonoscopy; however, large population studies have shown that despite resection of polypoid adenomas, interval colorectal cancers still occurred. Recent advances in technology have given today's endoscopists access to high-resolution and high-magnification scopes, which has facilitated detection of flat and depressed colorectal lesions. Current data suggest that such morphologically distinct lesions may account for up to 30% of all colorectal adenomas. Furthermore, flat and depressed lesions of the large bowel may confer greater malignant potential compared to polypoid adenomas. The majority of flat lesions show only subtle changes by conventional colonoscopy, but the use of stains, such as indigocarmine, in addition to magnification colonoscopy can enhance their detection significantly. In this paper, we discuss the rationale for detecting flat colorectal lesions. We explore the use of high-magnification colonoscopy and chromoendoscopy, with particular reference to the application of indigocarmine, in this patient group. We also discuss the novel therapeutic techniques now available for these lesions.
自20世纪70年代莫森首次提出腺瘤-癌序列以来，从结肠中检测并随后切除息肉状腺瘤可降低结直肠癌的发病率这一观点已被广泛接受。这些腺瘤通过传统结肠镜检查相对容易检测到；然而，大量人群研究表明，尽管切除了息肉状腺瘤，仍会发生间隔期结直肠癌。技术的最新进展使当今的内镜医师能够使用高分辨率和高放大倍数的内镜，这有助于检测扁平及凹陷性结直肠病变。目前的数据表明，这种形态学上不同的病变可能占所有结直肠腺瘤的30%。此外，与息肉状腺瘤相比，大肠的扁平及凹陷性病变可能具有更大的恶性潜能。大多数扁平病变在传统结肠镜检查中仅表现出细微变化，但除了放大结肠镜检查外，使用靛胭脂等染色剂可显著提高其检出率。在本文中，我们讨论检测扁平结直肠病变的基本原理。我们探讨高放大倍数结肠镜检查和色素内镜检查的应用，特别是靛胭脂在该患者群体中的应用。我们还讨论了目前可用于这些病变的新型治疗技术。
