Centorrino Erica, Ferrari Davide, Harmsen William S, Larson David W, Loftus Edward V, Coelho-Prabhu Nayantara
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Gastroenterology Residency Program, University of Milan, Milan, Italy.
Inflamm Bowel Dis. 2025 Jul 7;31(7):1952-1960. doi: 10.1093/ibd/izae274.
Patients with inflammatory bowel disease (IBD) have a higher risk of developing colorectal dysplasia and colorectal cancer compared to the general population. Although the use of surveillance protocols has improved the ability to detect dysplasia, some lesions are still missed at colonoscopy. This study aims to determine the rate of dysplastic lesions that are undetected at colonoscopies in IBD patients undergoing colectomy and to identify factors associated with missed dysplasia.
Patients who had received a total or subtotal colectomy at Mayo Clinic (Rochester, Minnesota), between January 2003 and December 2022, and had a complete colonoscopy within 5 years before surgery were retrospectively enrolled. Data abstracted included demographic information, disease-related data, colonoscopy and pathology reports, and surgery pathology reports. Colonoscopy and surgery findings were compared, and patients were divided into 3 groups: no dysplasia at both, detected dysplasia, and undetected dysplasia.
Among 1320 IBD patients undergoing colectomy, 5.4% had undetected dysplastic lesions identified only at surgery. Factors independently associated with dysplasia detection were endoscopic remission or mild endoscopic disease activity (odds ratio [OR], 2.326; P = .0081; 95% CI, 1.246-4.342), prior dysplasia detection (OR, 1.876; P = .0491; 95% CI, 1.002-3.511), colonoscopy performed for surveillance (OR, 2.380; P = .0048; 95% CI, 1.302-4.350), and longer disease duration at surgery (OR, 1.039; P = .0085; 95% CI, 1.010-1.070).
Clinicians should be aware of the risk of missing dysplastic lesions, especially when endoscopic disease activity is moderate/severe, and not only for longstanding disease. Efforts should be made to obtain endoscopic remission to make the "invisible" visible.
与普通人群相比，炎症性肠病（IBD）患者发生结直肠发育异常和结直肠癌的风险更高。尽管采用监测方案提高了检测发育异常的能力，但结肠镜检查时仍会漏诊一些病变。本研究旨在确定接受结肠切除术的IBD患者结肠镜检查未发现的发育异常病变的发生率，并确定与漏诊发育异常相关的因素。
回顾性纳入2003年1月至2022年12月在梅奥诊所（明尼苏达州罗切斯特）接受全结肠或次全结肠切除术且术前5年内进行了完整结肠镜检查的患者。提取的数据包括人口统计学信息、疾病相关数据、结肠镜检查和病理报告以及手术病理报告。比较结肠镜检查和手术结果，患者分为3组：两者均无发育异常、检测到发育异常和未检测到发育异常。
在1320例接受结肠切除术的IBD患者中，5.4%存在仅在手术中发现的未检测到的发育异常病变。与发育异常检测独立相关的因素为内镜缓解或轻度内镜疾病活动（比值比[OR]，2.326；P = 0.0081；95%可信区间[CI]，1.246 - 4.342）、既往检测到发育异常（OR，1.876；P = 0.0491；95%CI，1.002 - 3.511）、为监测目的进行的结肠镜检查（OR，2.380；P = 0.0048；95%CI，1.302 - 4.350）以及手术时疾病持续时间较长（OR，1.039；P = 0.0085；95%CI，1.010 - 1.070）。
临床医生应意识到漏诊发育异常病变的风险，尤其是在内镜疾病活动为中度/重度时，不仅对于病程较长的疾病。应努力实现内镜缓解以使“不可见”变为“可见”。
