National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.
Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Gut. 2019 Mar;68(3):562-572. doi: 10.1136/gutjnl-2017-315235. Epub 2018 Dec 22.
Endoscopic assessment of inflammation and mucosal healing is crucial for appropriate management in IBD. Current definition of endoscopic mucosal healing has been derived using previous generation of standard white light endoscopes. New endoscopy technologies widely available provide much more detailed images of mucosal and vascular patterns. Novel endoscopic techniques with high definition image, optical and digital enhancement have enhanced the quality and fine details of vascular and mucosal pattern so that endoscopic images have started to reflect histological changes for lesions and inflammation/healing. These technologies can now define subtle inflammatory changes and increase detection and characterisation of colonic lesions in patients with IBD. The best endoscopic technique to detect dysplasia in IBD is still debated. Dye chromoendoscopy with targeted biopsies is considered by Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in inflammatory Bowel Disease Patients: International Consensus Recommendations (SCENIC consensus the standard of care and recommended for adoption by gastroenterologists in practice. In future, it is possible that well-trained colonoscopists using high definition equipment with image enhancements may be able to obtain equivalent yield without pan-colonic dye spraying and characterise lesions. Finally, SCENIC introduced endoscopic resectability of some dysplastic colonic lesions-new techniques may now better characterise endoscopic resectability and limit the number of colectomies. In this review, we will provide a state-of-the-art opinion on the direction of technological advances in the assessment of IBD and how new concepts will refine clinical practice.
内镜评估炎症和黏膜愈合对于 IBD 的适当治疗至关重要。目前的内镜黏膜愈合定义是使用前一代标准白光内镜得出的。新的内镜技术广泛应用，提供了更详细的黏膜和血管模式图像。具有高清图像、光学和数字增强的新型内镜技术提高了血管和黏膜模式的质量和细微细节，使得内镜图像开始反映病变和炎症/愈合的组织学变化。这些技术现在可以定义细微的炎症变化，并增加对 IBD 患者结肠病变的检测和特征描述。用于检测 IBD 中异型增生的最佳内镜技术仍存在争议。染料染色内镜联合靶向活检被认为是炎症性肠病患者结直肠内镜下肿瘤检测和管理的监测：国际共识建议（SCENIC 共识）的标准治疗方法，建议胃肠病学家在实践中采用。将来，使用具有图像增强功能的高清设备进行训练有素的结肠镜检查者可能能够获得同等的效果，而无需全结肠喷洒染料，并对病变进行特征描述。最后，SCENIC 提出了一些异型增生性结肠病变的内镜可切除性——新技术现在可能更好地描述内镜可切除性，并减少结肠切除术的数量。在这篇综述中，我们将提供关于 IBD 评估技术发展方向的最新观点，以及新的概念将如何改进临床实践。
