Passos Márcio Alexandre Terra, Chaves Fernanda Correa, Chaves-Junior Nilson
Hospital Universitário de Vassouras, Universidade Severino Sombra, Vassouras, RJ, Brazil.
Arq Bras Cir Dig. 2018;31(2):e1374. doi: 10.1590/0102-672020180001e1374. Epub 2018 Jul 2.
Endoscopic evaluation, particularly the macroscopic mucosal and histological results of ileocolic biopsies, is essential for the management of inflammatory bowel disease. Endoscopic appearance is not always sufficient to differentiate Crohn's disease and ulcerative colitis, but there are some characteristics that favor one or another diagnosis. Both diseases have an increased incidence of colorectal carcinoma; so, surveillance colonoscopy is important for detecting early neoplastic lesions.
To update the importance of endoscopy in the evaluation, diagnosis and prognosis of inflammatory bowel disease.
Search was done in the scientific literature of the TRIP database, chosen from clinical questions (PICO) with the following descriptors: "inflammatory bowel disease", "endoscopy/colonoscopy", "Crohn's disease", "ulcerative colitis" and "diagnosis/treatment".
Endoscopic investigation in patients with chronic colitis is quite accurate for the differential diagnosis between ulcerative colitis and Crohn's disease. Endoscopy is indicated for ulcerative colitis during severe crisis due to its prognostic value. Another accepted indication for endoscopy in inflammatory bowel disease is its use in the screening for dysplastic lesion.
Ileocolonoscopy allows an accurate diagnosis of Crohn's disease or ulcerative colitis in up to 90% of cases. The healing of the mucosa assessed by endoscopy after treatments despite not being consensus is still the gold-standard in the evaluation of remission of the disease. Colonoscopy is essential for long-term cancer surveillance and in the future the implementation of Confocal Laser Endomicroscopy seems to be very promising in assessing the initial dysplasia.
内镜评估，尤其是回结肠活检的宏观黏膜和组织学结果，对于炎症性肠病的管理至关重要。内镜表现并不总是足以区分克罗恩病和溃疡性结肠炎，但存在一些有利于一种或另一种诊断的特征。这两种疾病的结直肠癌发病率均有所增加；因此，监测结肠镜检查对于检测早期肿瘤性病变很重要。
更新内镜检查在炎症性肠病评估、诊断和预后中的重要性。
在TRIP数据库的科学文献中进行检索，从具有以下描述词的临床问题（PICO）中选取：“炎症性肠病”、“内镜检查/结肠镜检查”、“克罗恩病”、“溃疡性结肠炎”以及“诊断/治疗”。
对于慢性结肠炎患者，内镜检查在溃疡性结肠炎和克罗恩病的鉴别诊断中相当准确。由于其预后价值，在溃疡性结肠炎严重发作时需进行内镜检查。内镜检查在炎症性肠病中的另一个公认适应证是用于筛查发育异常病变。
回结肠镜检查在高达90%的病例中能够准确诊断克罗恩病或溃疡性结肠炎。尽管治疗后通过内镜评估黏膜愈合情况尚未达成共识，但仍是评估疾病缓解的金标准。结肠镜检查对于长期癌症监测至关重要，并且在未来，共聚焦激光内镜显微镜的应用在评估初始发育异常方面似乎非常有前景。
