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炎症性肠病中图像增强内镜检查的现状

Current status of image-enhanced endoscopy in inflammatory bowel disease.

作者信息

Yang Young Joo

机构信息

Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.

出版信息

Clin Endosc. 2023 Sep;56(5):563-577. doi: 10.5946/ce.2023.070. Epub 2023 Sep 26.

Abstract

In inflammatory bowel disease (IBD), chronic inflammation leads to unfavorable clinical outcomes and increases the risk of developing colorectal neoplasm (CRN); thereby highlighting the importance of endoscopically evaluating disease activity as well as detecting and characterizing CRN in patients with IBD. With recent advances in image-enhanced endoscopic (IEE) technologies, especially virtual chromoendoscopy (VCE) platforms, this review discusses state-of-the-art IEE techniques and their applicability in assessing disease activity and surveillance colonoscopy in patients with IBD. Among various IEE, VCE demonstrated the capacity to identify quiescent disease activity. And endoscopic remission defined by the new scoring system using VCE platform better predicted clinical outcomes, which may benefit the tailoring of therapeutic strategies in patients with IBD. High-definition dye-chromoendoscopy (HD-DCE) is numerically superior to high-definition white light endoscopy (HD-WLE) in detecting CRN in IBD; however, discrepancy is observed in the statistical significance. VCE showed comparable performance in detecting dysplasia to HD-WLE or DCE and potential for optical diagnosis to differentiate neoplastic from nonneoplastic lesions during surveillance colonoscopy. Applying these novel advanced IEE technologies would provide opportunities for personalized medicine in IBD and optimal treatment of CRN in patients with IBD.

摘要

在炎症性肠病(IBD)中,慢性炎症会导致不良的临床结局,并增加患结直肠肿瘤(CRN)的风险;因此凸显了对IBD患者进行内镜评估疾病活动以及检测和鉴定CRN的重要性。随着图像增强内镜(IEE)技术的最新进展,尤其是虚拟染色内镜(VCE)平台的出现,本综述讨论了IEE的先进技术及其在评估IBD患者疾病活动和监测结肠镜检查中的适用性。在各种IEE中,VCE显示出识别静止期疾病活动的能力。使用VCE平台的新评分系统定义的内镜缓解能更好地预测临床结局,这可能有助于为IBD患者量身定制治疗策略。在检测IBD中的CRN方面,高清染料染色内镜(HD-DCE)在数值上优于高清白光内镜(HD-WLE);然而,在统计学意义上存在差异。VCE在检测发育异常方面与HD-WLE或DCE表现相当,并且在监测结肠镜检查期间具有光学诊断区分肿瘤性与非肿瘤性病变的潜力。应用这些新型先进的IEE技术将为IBD的个性化医疗以及IBD患者CRN的最佳治疗提供机会。

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