Dewit O, Fiasse R, Vanheuverzwyn R
Service de Gastro-entérologie, Cliniques Saint-Luc, UCL, Av. Hippocrate, 10, B-1200 Bruxelles, Belgique.
Acta Endoscopica. 2003;33(2):217-231. doi: 10.1007/BF03028414.
Two types of endoscopic lesions are observed in Crohn's disease (CD): active lesions or scars, frequently associated. Following their localization at different sites of the digestive tract, they are defining the type of disease. Ileo-colonoscopy is an important step of the initial characterization of the lesions, completed with biopsies helful for the differential diagnosis between CD and ulcerative colitis or infectious colitis An endoscopy is only repeated in front of a new clinical problem or when a change of treatment is required. In case of severe colitis, colonoscopy may detect septic lesions as well as deep ulcers indicating severe evolution with a bad prognosis. After surgery, in most of the cases ileocolonoscopy detects recurrent lesions whose severity is linked to an unfavourable clinical evolution and permits therapeutic adaptation. Since the risk of colorectal cancer in CD predominant in the colon is probaly underestimated, a systematic colonoscopy after 8 to 10 years of evolution should be performed for the screening of malignant lesions. Colonoscopy is also useful for the treatment of complications of CD, i. e. dilatation of benign strictures, as well as localization and treatment of distal bleeding. Upper digestive tract endoscopy, endosonography, enteroscopy, videocapsule and endoscopic retrograde cholangio-pancreatography are other contributive methods within the field of correct indications.
在克罗恩病（CD）中可观察到两种类型的内镜下病变：活动性病变或瘢痕，二者常同时出现。根据它们在消化道不同部位的定位，可确定疾病类型。回结肠镜检查是病变初始特征描述的重要步骤，辅以活检有助于鉴别CD与溃疡性结肠炎或感染性结肠炎。仅在出现新的临床问题或需要改变治疗方案时才重复进行内镜检查。在重症结肠炎的情况下，结肠镜检查可发现脓毒性病变以及提示预后不良的严重进展的深部溃疡。手术后，在大多数情况下，回结肠镜检查可发现复发病变，其严重程度与不良临床进展相关，并有助于调整治疗。由于CD患者结肠中结直肠癌的风险可能被低估，因此病程8至10年后应进行系统的结肠镜检查以筛查恶性病变。结肠镜检查对CD并发症的治疗也很有用，即良性狭窄扩张以及远端出血的定位和治疗。上消化道内镜检查、超声内镜检查、小肠镜检查、视频胶囊内镜检查和内镜逆行胰胆管造影是在正确适应证范围内的其他辅助检查方法。
