Schmidt C, Bielecki C, Felber J, Stallmach A
Department of Gastroenterology, Hepatology and Infectiology, Friedrich-Schiller University, Jena, Germany.
Minerva Gastroenterol Dietol. 2010 Jun;56(2):189-201.
Patients with longstanding ulcerative colitis (UC) are at increased risk of developing colorectal cancer (CRC). Although data for CRC risk in Crohn's disease (CD) are limited, it has been suggested that the risk is comparable to UC. Current strategies for the prevention and early detection of cancer in this high risk population are based on the concept of an inflammation-neoplasia-carcinoma sequence. To reduce CRC mortality in inflammatory bowel disease (IBD), colonoscopic surveillance with random and targeted biopsies are recommended to detect early neoplasia. The introduction of novel endoscopic techniques such as conventional or virtual chromoendoscopy to facilitate targeted biopsies or confocal laser endomicroscopy to further characterise suspicious lesions has become increasingly associated with enhanced neoplasia detection. However, there is only indirect evidence that such surveillance strategies are likely to be effective in reducing the risk of death from IBD-associated CRC. Furthermore, new data suggests that surveillance strategies largely based upon disease duration are leading to delayed or missed diagnosis of early CRC in a substantial number of patients. Therefore, current surveillance guidelines seem to lack efficacy and need to be reassessed.
患有长期溃疡性结肠炎（UC）的患者患结直肠癌（CRC）的风险增加。尽管关于克罗恩病（CD）患CRC风险的数据有限，但有人认为其风险与UC相当。目前针对这一高危人群预防和早期发现癌症的策略基于炎症-瘤变-癌序列的概念。为降低炎症性肠病（IBD）患者的CRC死亡率，建议通过结肠镜检查并进行随机和靶向活检以检测早期瘤变。新型内镜技术的引入，如传统或虚拟色素内镜检查以促进靶向活检，或共聚焦激光显微内镜检查以进一步明确可疑病变，与瘤变检测的增强越来越相关。然而，仅有间接证据表明此类监测策略可能有效降低IBD相关CRC的死亡风险。此外，新数据表明，主要基于病程的监测策略导致大量患者早期CRC的诊断延迟或漏诊。因此，目前的监测指南似乎缺乏有效性，需要重新评估。
