Buchner Anna M
Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania.
Gastroenterol Hepatol (N Y). 2021 Mar;17(3):121-127.
Patients with inflammatory bowel disease (IBD) have a higher risk of developing colitis-associated dysplastic lesions. Surveil-lance colonoscopy with endoscopic imaging techniques such as chromoendoscopy has been suggested. However, complex dysplastic lesions of larger size, challenging location behind folds, and nonpolypoid morphology defy standard polypectomy techniques and require advanced management with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). When technically feasible for visible dysplasia with distinct margins, these endoscopic procedures have replaced the traditional approach of surgical management. Recent guidelines support careful endoscopic inspection of the colonic mucosa with high-definition colonoscopes and the application of imaging techniques such as chromoendoscopy to enhance lesion detection and characterization as well as to help determine whether endoscopic management is an effective alternative to colectomy. Endoscopic resection techniques such as EMR and ESD have become key modalities in the management of endoscopically resectable dysplasia in patients with IBD.
炎症性肠病（IBD）患者发生结肠炎相关发育异常病变的风险更高。有人建议采用诸如色素内镜等内镜成像技术进行监测结肠镜检查。然而，较大尺寸、位于皱襞后方具有挑战性位置以及非息肉样形态的复杂发育异常病变难以用标准息肉切除术处理，需要采用内镜黏膜切除术（EMR）或内镜黏膜下剥离术（ESD）进行高级处理。当对边界清晰的可见发育异常在技术上可行时，这些内镜手术已取代了传统的手术管理方法。最近的指南支持使用高清结肠镜对结肠黏膜进行仔细的内镜检查，并应用诸如色素内镜等成像技术来提高病变检测和特征描述能力，以及帮助确定内镜管理是否是结肠切除术的有效替代方法。诸如EMR和ESD等内镜切除技术已成为IBD患者内镜可切除发育异常管理的关键方式。
