Department of Gastroenterology and Hepatology Surgery Pathology, University of Amsterdam, Amsterdam, The Netherlands.
Colorectal Dis. 2012 Apr;14(4):469-73. doi: 10.1111/j.1463-1318.2011.02669.x.
A recent systematic review indicated that dysplasia present before restorative proctocolectomy is a predictor of subsequent dysplasia in the pouch. This prospective study was carried out to assess the prevalence of dysplasia in the ileal pouch in patients having RPC for ulcerative colitis with co-existing dysplasia in the operation specimen.
Eligible patients were invited for a surveillance endoscopy. The afferent and blind efferent ileal loop, ileoanal pouch and rectal cuff were examined by standard endoscopy using a dye-spray technique with methylene blue. Mucosal abnormalities were biopsied and random biopsies were taken from the afferent and blind ileal loop, pouch and rectal cuff.
Fourty-four patients (25 male, mean 49 years) underwent pouch endoscopy at a mean interval from RPC of 8.6 years. Dysplasia was detected in two (4.5%) patients. In one, low-grade dysplasia was found in the rectal cuff and in the other low-grade dysplasia was detected in random biopsies from the pouch and the efferent ileal loop.
This prospective pouch-endoscopy study detected dysplasia in < 5% of patients over nearly 10 years. The benefit of routine surveillance for dysplasia in the pouch is uncertain, as the significance of low-grade dysplasia in the pouch is not clear.
最近的一项系统评价表明，在修复性直肠结肠切除术之前存在异型增生是直肠袋内随后出现异型增生的预测因素。本前瞻性研究旨在评估溃疡性结肠炎伴并存异型增生的患者行 RPC 后，在直肠袋内存在异型增生的患者中，直肠袋内异型增生的发生率。
邀请符合条件的患者进行监测性内镜检查。使用亚甲蓝染色喷雾技术对回肠输入襻和盲袢、回肠肛管吻合袋和直肠袖套进行标准内镜检查。对黏膜异常进行活检，并从回肠输入襻和盲袢、吻合袋和直肠袖套随机活检。
44 名患者（25 名男性，平均年龄 49 岁）在 RPC 后平均 8.6 年进行了吻合袋内镜检查。两名（4.5%）患者发现异型增生。其中 1 例直肠袖套中发现低级别异型增生，另 1 例吻合袋和回肠输出襻的随机活检中发现低级别异型增生。
这项前瞻性的吻合袋内镜检查研究在近 10 年内发现 < 5%的患者存在异型增生。在直肠袋内常规监测异型增生的益处尚不确定，因为直肠袋内低级别异型增生的意义尚不清楚。
