Limdi Jimmy K, Farraye Francis A
Pennine Acute Hospitals NHS Trust, Section of Inflammatory Bowel Diseases, Department of Gastroenterology, Institute of Inflammation and Repair, Manchester Academic Health Sciences, University of Manchester, Manchester, UK.
Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Curr Gastroenterol Rep. 2018 Mar 7;20(2):7. doi: 10.1007/s11894-018-0612-2.
Patients with long-standing ulcerative colitis have an increased risk for the development of colorectal cancer (CRC). Colitis-related dysplasia appears to confer the greatest risk. Colonoscopic surveillance to detect dysplasia has been advocated by gastrointestinal societies. The aim of surveillance is the reduction of mortality and morbidity of CRC through detection and resection of dysplasia or detecting CRC at an earlier and potentially curable stage. Traditional surveillance has relied on mucosal assessment with targeted biopsy of visible lesions and random biopsy sampling on the premise that dysplasia was not visible at endoscopy. Advances in optical technology permitting increased detection of dysplasia and evidence that most dysplasia is visible has had practice-changing implications.
Emerging evidence favours chromoendoscopy (CE) for dysplasia detection and is gaining wider acceptance through recent international (International Consensus Statement on Surveillance and Management of Dysplasia in Inflammatory Bowel Disease (SCENIC)) recommendations and endorsed by many gastrointestinal societies. Adoption of CE as the gold standard of surveillance has been met with by scepticism, from conflicting data, operational barriers and the need to understand the true impact of increasingly higher dysplasia detection on overall CRC mortality. Valid debate notwithstanding, implementation of a risk stratification protocol that includes CE is an effective approach allowing earlier detection of dysplasia and colorectal neoplasia, determination of surveillance intervals with appropriate allocation of resources and limiting morbidity from CRC and colonoscopy itself. Further prospective data should define the true and long-term impact of dysplasia detection with modern techniques.
长期溃疡性结肠炎患者患结直肠癌（CRC）的风险增加。结肠炎相关发育异常似乎带来最大风险。胃肠病学会提倡通过结肠镜监测来检测发育异常。监测的目的是通过检测和切除发育异常或在更早且可能可治愈的阶段检测到CRC，从而降低CRC的死亡率和发病率。传统监测依赖于对可见病变进行靶向活检以及随机活检采样，前提是在内镜检查时发育异常不可见。光学技术的进步使得发育异常的检测增加，并且有证据表明大多数发育异常是可见的，这对实践产生了变革性影响。
新出现的证据支持采用色素内镜检查（CE）来检测发育异常，并且通过最近的国际（《炎症性肠病发育异常监测与管理国际共识声明》（SCENIC））建议，CE正获得更广泛的认可，并得到许多胃肠病学会的支持。将CE作为监测的金标准受到了质疑，原因包括相互矛盾的数据、操作障碍以及需要了解发育异常检测率不断提高对总体CRC死亡率的真正影响。尽管存在合理的争议，但实施包括CE的风险分层方案是一种有效的方法，可实现更早地检测发育异常和结直肠肿瘤，确定监测间隔并合理分配资源，同时限制CRC和结肠镜检查本身带来的发病率。进一步的前瞻性数据应明确现代技术检测发育异常的真正和长期影响。
