Naymagon Steven, Ullman Thomas A
Dr Naymagon is an assistant professor of medicine and Dr Ullman is an associate professor of medicine in the Henry D. Janowitz Division of Gastroenterology at the Icahn School of Medicine at Mount Sinai in New York, New York.
Gastroenterol Hepatol (N Y). 2015 May;11(5):304-11.
The evidence supporting the practice of dysplasia surveillance in inflammatory bowel disease (IBD) has remained sparse, and optimal detection strategies are still lacking. These issues, added to the declining incidence of dysplasia in IBD, have led to much debate over the diagnosis and management of dysplasia. White-light endoscopy with targeted and random biopsies remains the technique of choice for most practicing gastroenterologists. However, during the past decade, a surge of literature has questioned the efficacy of this strategy. Simultaneously, chromoendoscopy has emerged as an alternative, and perhaps superior, technique that has been included in some society guidelines. Nevertheless, many issues remain unclear, such as the best way to implement chromoendoscopy into everyday practice, whether there are any outcome benefits that can be attributed to the use of chromoendoscopy, and, perhaps most importantly, how to manage dysplasia uncovered by this and other advanced techniques. In this article, we discuss the various techniques currently available for dysplasia surveillance in IBD, with a focus on chromoendoscopy. Additionally, we highlight the overarching issues of setting appropriate endpoints and individualizing the care of patients with long-standing colitis.
支持在炎症性肠病（IBD）中进行发育异常监测的证据仍然不足，并且仍缺乏最佳检测策略。这些问题，再加上IBD中发育异常发病率的下降，引发了关于发育异常诊断和管理的诸多争论。白光内镜检查结合靶向活检和随机活检仍是大多数胃肠病医生的首选技术。然而，在过去十年中，大量文献对该策略的有效性提出了质疑。同时，色素内镜检查已成为一种替代技术，甚至可能是更优技术，已被纳入一些学会指南。尽管如此，许多问题仍不明确，例如将色素内镜检查应用于日常实践的最佳方法、使用色素内镜检查是否有任何可归因的结果益处，以及也许最重要的是，如何处理通过这种及其他先进技术发现的发育异常。在本文中，我们讨论了目前可用于IBD发育异常监测的各种技术，重点是色素内镜检查。此外，我们强调了设定适当终点以及对长期结肠炎患者进行个体化护理的首要问题。
