East James E, Toyonaga Takashi, Suzuki Noriko
Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK.
Department of Endoscopy, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chou-ku, Kobe, Hyogo 650-0017, Japan.
Gastrointest Endosc Clin N Am. 2014 Jul;24(3):435-45. doi: 10.1016/j.giec.2014.03.003. Epub 2014 May 6.
Much of the flat or biopsy-only detected dysplasia in inflammatory bowel disease (IBD) that had historically warranted a colectomy can now be shown to be circumscribed lesions with dye-spray or advanced endoscopic imaging. These lesions are therefore amenable to endoscopic excision with close endoscopic follow-up, though are technically very challenging. This review discusses preresection assessment of nonpolypoid or flat (Paris 0-II) lesions in colitis; lifting with colloids or hyaluronate; endoscopic mucosal resection (EMR) with spiral or flat ribbon snares; or simplified, hybrid, and full endoscopic submucosal dissection (ESD); as well as mucosal ablation. Close follow-up postresection is mandatory.
在炎症性肠病（IBD）中，许多过去需要进行结肠切除术的扁平或仅通过活检检测到的发育异常，现在可以通过染料喷洒或先进的内镜成像显示为局限性病变。因此，这些病变适合进行内镜切除并密切内镜随访，尽管技术上极具挑战性。本综述讨论了结肠炎中非息肉样或扁平（巴黎0-II型）病变的切除前评估；使用胶体或透明质酸盐进行抬举；使用螺旋或扁平带状圈套器进行内镜黏膜切除术（EMR）；或简化、混合及全层内镜黏膜下剥离术（ESD）；以及黏膜消融。切除后必须进行密切随访。
