Blonski Wojciech, Kundu Rabi, Lewis James, Aberra Faten, Osterman Mark, Lichtenstein Gary R
Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4283, USA.
Scand J Gastroenterol. 2008;43(6):698-703. doi: 10.1080/00365520701866150.
Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer. It was widely believed that dysplastic lesions are invisible on colonoscopy and can only be detected by random biopsies, as 95% of dysplastic lesions occur in flat colonic mucosa indistinct from surrounding tissue. The aim of this study was to determine whether dysplasia is visible during routine surveillance colonoscopy by evaluating only patients who had dysplasia without overt carcinoma.
The medical records, endoscopy and pathology databases were systematically reviewed between 1997 and 2004 at the University of Pennsylvania Health System. Patients with inflammatory bowel disease and dysplasia were identified and their medical charts reviewed.
Of the 113 patients with colonic dysplasia confirmed by pathology at our center, 102 (90%) had UC. Forty-nine of the 102 (48%) patients with UC underwent colonoscopic evaluation prior to dysplasia detection. This group was selected as our study cohort. Overall, 72 macroscopic abnormalities were detected at 49 colonoscopies, including 55 polypoid lesions, 12 areas of ulceration, 3 areas of nodularity, 1 irregular hemicircumferential lesion and 1 area of stricture. Overall, 58 dysplastic sites were detected; 51 were macroscopically visible (87.9%) and 7 were macroscopically invisible (12.1%).
Most of the dysplasia in UC is endoscopically visible, but further prospective evaluation of a large number of patients is needed to validate the current observations. Our findings have the potential to modify current recommendations for surveillance biopsies in UC if validated by prospective studies.
溃疡性结肠炎（UC）患者患结直肠癌的风险增加。人们普遍认为，发育异常病变在结肠镜检查中不可见，只能通过随机活检检测到，因为95%的发育异常病变发生在与周围组织无明显差异的平坦结肠黏膜中。本研究的目的是通过仅评估患有发育异常但无明显癌的患者，来确定在常规监测结肠镜检查期间发育异常是否可见。
对1997年至2004年宾夕法尼亚大学医疗系统的病历、内镜检查和病理数据库进行系统回顾。确定患有炎症性肠病和发育异常的患者，并查阅他们的病历。
在我们中心经病理证实的113例结肠发育异常患者中，102例（90%）患有UC。102例UC患者中有49例（48%）在发育异常检测之前接受了结肠镜检查评估。该组被选为我们的研究队列。总体而言，在49次结肠镜检查中检测到72处宏观异常，包括55个息肉样病变、12处溃疡区域、3处结节区域、1处不规则半周病变和1处狭窄区域。总体而言，检测到58个发育异常部位；51个在宏观上可见（87.9%），7个在宏观上不可见（12.1%）。
UC中的大多数发育异常在结肠镜检查中可见，但需要对大量患者进行进一步的前瞻性评估以验证当前的观察结果。如果前瞻性研究证实，我们的发现有可能改变目前UC监测活检的建议。
