Islam Bianca, Nguyen Vu
Department of Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Clin Colon Rectal Surg. 2023 Mar 8;37(1):13-17. doi: 10.1055/s-0043-1762558. eCollection 2024 Jan.
Patients with inflammatory bowel disease (IBD) have increased risk of colorectal cancer (CRC). The risk for CRC is positively correlated to the duration of disease, extent of colonic involvement, and severity of inflammation. After 8 to 10 years of IBD diagnosis, the risk for CRC rises substantially and screening colonoscopy is recommended. Surveillance colonoscopy interval ranges from 1 to 5 years depending on patient and disease-specific risk factors. IBD patients with high risk factors such as having concomitant primary sclerosing cholangitis, moderate-to-severe inflammation, first-degree relative with CRC at early age, or history of invisible dysplasia or high-risk visible dysplasia should undergo surveillance colonoscopy in 1 year. Meanwhile, those with minimal colonic involvement or ≥2 consecutive unremarkable examinations while in continuous remission may consider extending the surveillance interval to 5 years. Advance in colonoscopy technique such as chromoendoscopy using dyes and/or image digital processing (virtual chromoendoscopy) may enhance dysplasia detection and is the preferred method for IBD surveillance. In the era of high-definition colonoscope, the practice of obtaining extensive biopsies throughout the colon remains controversial but is generally recommended to improve the detection rate of invisible dysplasia. Endoscopic surveillance in IBD has been shown to result in earlier detection of CRC and improved prognosis.
炎症性肠病（IBD）患者患结直肠癌（CRC）的风险增加。患CRC的风险与疾病持续时间、结肠受累程度和炎症严重程度呈正相关。IBD诊断后8至10年，CRC风险大幅上升，建议进行结肠镜筛查。监测结肠镜检查的间隔时间为1至5年，具体取决于患者和疾病特定的风险因素。具有高风险因素的IBD患者，如合并原发性硬化性胆管炎、中重度炎症、幼年时有CRC的一级亲属，或有隐匿性发育异常或高危可见发育异常病史，应在1年内接受监测结肠镜检查。同时，那些结肠受累程度最小或在持续缓解期间连续≥2次检查无异常的患者可考虑将监测间隔延长至5年。结肠镜检查技术的进步，如使用染料的色素内镜检查和/或图像数字处理（虚拟色素内镜检查），可能会提高发育异常的检测率，是IBD监测的首选方法。在高清结肠镜时代，在整个结肠进行广泛活检的做法仍存在争议，但一般建议这样做以提高隐匿性发育异常的检出率。IBD的内镜监测已被证明可导致CRC的早期发现并改善预后。
