Kaltenbach Tonya, Holmes Ian, Nguyen-Vu Tiffany, Malvar Carmel, Balitzer Dana, Fong Dean, Fu Aurelia, Shergill Amandeep, McQuaid Kenneth, Soetikno Roy
Veterans Affairs San Francisco Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Veterans Affairs San Francisco Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Gastrointest Endosc. 2023 May;97(5):934-940. doi: 10.1016/j.gie.2023.01.019. Epub 2023 Jan 14.
Patients with inflammatory bowel disease (IBD) are at risk of developing dysplasia. According to the Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations, "After complete removal of endoscopically resectable nonpolypoid dysplastic lesions, surveillance colonoscopy is suggested rather than colectomy." We sought to add data to the literature and hypothesized that the endoscopic resection of nonpolypoid colorectal dysplasia (NP-CRD) is safe and effective.
We conducted a retrospective study of a large cohort of patients with IBD at 2 medical centers who underwent colonoscopy between 2007 and 2018. Patients with at least 1 nonpolypoid lesion ≥10 mm were identified. We measured the feasibility of endoscopic resection, incidence of local recurrence, incidence of cancer, need for surgery, and frequency of adverse events.
We studied 326 patients who underwent a mean ± standard deviation of 3.6 ± 3.0 (range, 1-16) colonoscopies during a total follow-up of 1208 patient-years. In 36 patients, 161 lesions ≥10 mm were identified, 63 of which were nonpolypoid (mean size, 17.8 ± 8.9 mm; range, 10-45 mm) (prevalence, 7.7%). The majority of nonpolypoid lesions (96.8% [61 of 63]) were managed endoscopically. Four lesions (mean index lesion size, 32.5 ±11.0 mm) had small local recurrences that were successfully retreated with endoscopy. There were no severe adverse events related to IBD or colorectal cancer observed in the follow-up period.
In this IBD cohort, surveillance colonoscopy rather than colectomy was found to be safe and effective in patients with NP-CRD after undergoing endoscopic resection. After complete removal of endoscopically resectable NP-CRD, surveillance colonoscopy should be considered a safe and effective first-line strategy rather than colectomy.
炎症性肠病（IBD）患者有发生发育异常的风险。根据《炎症性肠病患者结直肠内镜下肿瘤的监测、检测与管理：国际共识推荐》，“在内镜下完全切除可切除的非息肉样发育异常病变后，建议进行监测性结肠镜检查而非结肠切除术。”我们试图补充文献数据，并假设非息肉样结直肠发育异常（NP-CRD）的内镜切除是安全有效的。
我们对2个医疗中心一大群在2007年至2018年间接受结肠镜检查的IBD患者进行了一项回顾性研究。确定至少有1个直径≥10 mm的非息肉样病变的患者。我们评估了内镜切除的可行性、局部复发率、癌症发生率、手术需求以及不良事件的发生频率。
我们研究了326例患者，在总共1208患者年的随访期间，他们平均接受了3.6±3.0次（范围1 - 16次）结肠镜检查。在36例患者中，发现161个直径≥10 mm的病变，其中63个为非息肉样病变（平均大小17.8±8.9 mm；范围10 - 45 mm）（患病率7.7%）。大多数非息肉样病变（96.8%[63个中的61个]）通过内镜治疗。4个病变（平均索引病变大小32.5±11.0 mm）出现小的局部复发，通过内镜成功再次治疗。随访期间未观察到与IBD或结直肠癌相关的严重不良事件。
在这个IBD队列中，对于NP-CRD患者，在内镜切除后，监测性结肠镜检查而非结肠切除术被发现是安全有效的。在内镜下完全切除可切除的NP-CRD后，监测性结肠镜检查应被视为一种安全有效的一线策略，而非结肠切除术。
