Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Gastroenterology and Hepatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Am J Gastroenterol. 2023 Oct 1;118(10):1748-1755. doi: 10.14309/ajg.0000000000002460. Epub 2023 Aug 7.
As medical management of inflammatory bowel disease makes great advances, most patients with inflammatory bowel disease will have long life expectancies without need for total colectomy. With prolonged disease duration, however, there is increased risk of dysplasia leading to colorectal cancer. Multiple consensus and guideline documents have been published over the last decade with recommendations to optimize early detection and management of dysplastic lesions. Endoscopic technology has improved tremendously, even over the past few years. Previously invisible dysplasia has become visible in most cases with advanced imaging technologies that now allow for much clearer and more detailed mucosal inspection. New tools to facilitate endoscopic resection of visible lesions have also enabled patients to avoid colectomy, with resulting need to continue colon surveillance. There are limited or conflicting data leading to inconsistent recommendations regarding the need for random biopsies, the preferred endoscopic imaging technique, and surveillance intervals after resection of dysplasia. Similarly, there remains significant variability in the application of guidelines into daily practice and availability of and training with advanced imaging technologies. Here, we present a narrative review of which patients are at highest risk for dysplasia, the current guidelines on surveillance colonoscopy, factors affecting optimal mucosal visualization, enhanced imaging techniques, standardized reporting terminologies for surveillance colonoscopy, endoscopic management of dysplasia, indications for colectomy, and briefly on future potential technologies to assist in dysplasia detection.
随着炎症性肠病的医学管理取得重大进展，大多数炎症性肠病患者的预期寿命将无需进行全结肠切除术。然而，随着疾病持续时间的延长，发生异型增生导致结直肠癌的风险增加。过去十年中已经发表了多项共识和指南文件，建议优化异型增生病变的早期检测和管理。内镜技术得到了极大的改善，甚至在过去几年中也是如此。以前看不见的异型增生在大多数情况下都可以通过先进的成像技术看到，这些技术现在可以提供更清晰、更详细的黏膜检查。新的工具也有助于内镜下切除可见病变，使患者能够避免结肠切除术，从而需要继续进行结肠监测。关于随机活检的必要性、首选的内镜成像技术以及异型增生切除后的监测间隔等问题，目前的数据有限或存在冲突，导致建议不一致。同样，指南在日常实践中的应用以及先进成像技术的可用性和培训方面也存在很大差异。在这里，我们对哪些患者最容易发生异型增生、目前的监测结肠镜检查指南、影响最佳黏膜可视化的因素、增强成像技术、监测结肠镜检查的标准化报告术语、异型增生的内镜管理、结肠切除术的适应证以及简要介绍未来可能有助于异型增生检测的技术进行了叙述性综述。
