Department of Gastroenterology, Hepatology and Infectiology, Friedrich Schiller University, Jena, Germany.
Dig Dis. 2009;27(4):584-90. doi: 10.1159/000233302. Epub 2009 Nov 4.
Nowadays, it is considered as an established fact that patients with long-standing ulcerative colitis (UC) are at an increased risk of developing colorectal cancer (CRC). Although data for CRC risk in Crohn's disease (CD) are not as extensive, it has been suggested that the risks are comparable to UC. Current strategies for the prevention and early detection of cancer in this high-risk population are grounded in the concept of an inflammation-neoplasia-carcinoma sequence. To reduce CRC mortality in inflammatory bowel disease, colonoscopic surveillance with random and targeted biopsies were recommended to detect early neoplasia. The introduction of novel endoscopic techniques such as chromoendoscopy, narrow band imaging or confocal endomicroscopy to facilitate targeted biopsy has become increasingly associated with enhanced neoplasia detection. However, there is only indirect evidence that such surveillance strategies are likely to be effective at reducing the risk of death from inflammatory bowel disease-associated CRC. Further, new data revealed that surveillance strategies largely based upon disease duration delayed or missed a substantial number of patients with early CRC. Therefore, actual surveillance guidelines seem to be insufficient and need to be restructured.
如今，人们普遍认为，长期患有溃疡性结肠炎（UC）的患者患结直肠癌（CRC）的风险增加。虽然克罗恩病（CD）发生 CRC 的风险数据并不广泛，但据提示，其风险与 UC 相当。目前，针对这一高危人群的癌症预防和早期检测策略基于炎症-肿瘤-癌序列的概念。为降低炎症性肠病患者的 CRC 死亡率，推荐进行结肠镜监测并随机和靶向活检，以检测早期肿瘤。新型内镜技术，如 chromoendoscopy、narrow band imaging 或 confocal endomicroscopy 的引入，有助于进行靶向活检，从而提高了肿瘤的检测率。然而，只有间接证据表明，这种监测策略可能有助于降低炎症性肠病相关 CRC 的死亡风险。此外，新数据显示，主要基于疾病持续时间的监测策略延迟或错过了大量早期 CRC 患者。因此，实际的监测指南似乎不足，需要进行重组。
