Guerrero Vinsard Daniela, Lennon Ryan, Avvaru Himaja Kumari, Patel Mehrie, Lahori Simmy, Raffals Laura E, Coelho-Prabhu Nayantara
Gastroenterology and Hepatology, Minneapolis VA Medical Center, Minneapolis, United States.
Gastroenterology, Mayo Clinic, Rochester, United States.
Endosc Int Open. 2024 Jan 30;12(1):E145-E154. doi: 10.1055/a-2204-8166. eCollection 2024 Jan.
Chronically inflamed colonic mucosa is primed to develop dysplasia identified at surveillance colonoscopy by targeted or random biopsies. We aimed to explore the effect of mucosal inflammation on detection of visible and "invisible" dysplasia and the concordance between the degree of endoscopic and histologic inflammation. This was a 6-year cross-sectional analysis of endoscopic and histologic data from IBD. A multinomial model was created to estimate the odds for a specific lesion type as well as the odds of random dysplasia relative to the degree of inflammation. Kappa statistics were used to measure concordance between endoscopic and histologic inflammation. A total of 3437 IBD surveillance colonoscopies between 2016-2021 were reviewed with 970 procedures from 721 patients containing 1603 visible lesions. Kappa agreement between histologic and endoscopic degree of inflammation was low at 0.4. There was a positive association between increased endoscopic inflammation and presence of tubulovillous adenomas (TVAs) (odds ratio [OR] 2.18; 95% confidence interval [CI] 1.03-4.62; =0.04). Among cases with visible lesions, the yield of concomitant random dysplasia was 2.7% and 1.9% for random indefinite dysplasia. The odds of random dysplasia significantly increased as the degree of endoscopic and histologic inflammation increased (OR 2.18, 95%CI 1.46-3.26; <0.001 and OR 2.75; 95%CI 1.65-4.57, <0.001, respectively. The odds of indefinite random dysplasia also significantly increased as endoscopic and histologic inflammation increased (OR 2.90; 95%CI 1.85, 4.55, <0.001 and OR 1.98; 95%CI 1.08, 3.62, <0.035, respectively. Endoscopic and histologic inflammation are associated with higher odds of finding TVAs and random low-grade, high-grade, and indefinite dysplasia. Concordance between histologic and endoscopic inflammation severity is low.
慢性炎症的结肠黏膜易于发展为发育异常，这可通过监测结肠镜检查时的靶向或随机活检来确定。我们旨在探讨黏膜炎症对可见和“不可见”发育异常检测的影响，以及内镜和组织学炎症程度之间的一致性。这是一项对炎症性肠病（IBD）的内镜和组织学数据进行的为期6年的横断面分析。创建了一个多项模型来估计特定病变类型的几率以及相对于炎症程度的随机发育异常的几率。kappa统计量用于衡量内镜和组织学炎症之间的一致性。回顾了2016年至2021年间共3437例IBD监测结肠镜检查，其中来自721例患者的970例检查包含1603个可见病变。组织学和内镜炎症程度之间的kappa一致性较低，为0.4。内镜炎症增加与绒毛状腺瘤（TVA）的存在呈正相关（优势比[OR]2.18；95%置信区间[CI]1.03 - 4.62；P = 0.04）。在有可见病变的病例中，伴随随机发育异常的检出率为2.7%，随机不确定发育异常的检出率为1.9%。随着内镜和组织学炎症程度的增加，随机发育异常的几率显著增加（OR分别为2.18，95%CI 1.46 - 3.26；P < 0.001和OR 2.75；95%CI 1.65 - 4.57，P < 0.001）。随机不确定发育异常的几率也随着内镜和组织学炎症的增加而显著增加（OR分别为2.90；95%CI 1.85，4.55，P < 0.001和OR 1.98；95%CI 1.08，3.62，P < 0.035）。内镜和组织学炎症与发现TVA以及随机低级别、高级别和不确定发育异常的较高几率相关。组织学和内镜炎症严重程度之间的一致性较低。
