St Mark's Hospital, Harrow, UK.
Imperial College London, London, UK.
Aliment Pharmacol Ther. 2020 Jul;52(1):5-19. doi: 10.1111/apt.15778. Epub 2020 May 20.
The prognosis of dysplasia in patients with IBD is largely determined from observational studies from the pre-videoendoscopic era (pre-1990s) that does not reflect recent advances in endoscopic imaging and resection.
To better understand the risk of synchronous colorectal cancer and metachronous advanced neoplasia (ie high-grade dysplasia or cancer) associated with dysplasia diagnosed in the videoendoscopic era, and to stratify risk according to a lesion's morphology, endoscopic resection status or whether it was incidentally detected on biopsy of macroscopically normal colonic mucosa (ie invisible).
A systematic search of original articles published between 1990 and February 2020 was performed. Eligible studies reported on incidence of advanced neoplasia at follow-up colectomy or colonoscopy for IBD-dysplasia patients. Quantitative and qualitative analyses were performed.
Thirty-three studies were eligible for qualitative analysis (five for the meta-analysis). Pooled estimated proportions of incidental synchronous cancers found at colectomy performed for a pre-operative diagnosis of visible high-grade dysplasia, invisible high-grade dysplasia, visible low-grade dysplasia and invisible low-grade dysplasia were 13.7% (95% CI 0.0-54.1), 11.4% (95% CI 4.6-20.3), 2.7% (95% CI 0.0-7.1) and 2.4% (95% CI 0.0-8.5) respectively. The lowest incidences of metachronous advanced neoplasia, for dysplasia not managed with immediate colectomy but followed up with surveillance, tended to be reported by the studies where high definition imaging and/or chromoendoscopy was used and endoscopic resection of visible dysplasia was histologically confirmed.
The prognosis of IBD-dysplasia diagnosed in the videoendoscopic era appears to have been improved but the quality of evidence remains low. Larger, prospective studies are needed to guide management. PROSPERO registration no: CRD42019105736.
在炎症性肠病（IBD）患者中，对发育不良的预测在很大程度上取决于视频内镜检查前时代（20 世纪 90 年代前）的观察性研究，这些研究并不能反映内镜成像和切除的最新进展。
更好地了解在视频内镜检查时代诊断的发育不良相关的结直肠癌和同时性高级别肿瘤（即高级别发育不良或癌症）的风险，并根据病变形态、内镜切除情况或在肉眼正常的结肠黏膜活检中偶然发现（即不可见）对风险进行分层。
对 1990 年至 2020 年 2 月期间发表的原始文章进行了系统检索。符合条件的研究报告了 IBD 发育不良患者在接受随访结肠切除术或结肠镜检查时高级别肿瘤的发生率。进行了定量和定性分析。
33 项研究符合定性分析（5 项进行荟萃分析）的条件。汇总分析显示，术前诊断为可见高级别发育不良、不可见高级别发育不良、可见低级别发育不良和不可见低级别发育不良的患者在接受手术前诊断为可见高级别发育不良的情况下，偶然发现同时性癌症的估计比例分别为 13.7%（95%CI 0.0-54.1）、11.4%（95%CI 4.6-20.3）、2.7%（95%CI 0.0-7.1）和 2.4%（95%CI 0.0-8.5）。对于未立即行结肠切除术但接受监测随访的发育不良患者，报道的最高发生率为高级别肿瘤，这似乎与使用高清成像和/或染色内镜以及对可见发育不良的内镜切除进行组织学确认的研究有关。
在视频内镜检查时代诊断的 IBD 发育不良的预后似乎有所改善，但证据质量仍然较低。需要更大的前瞻性研究来指导管理。PROSPERO 注册号：CRD42019105736。
