溃疡性结肠炎相关肿瘤的监测和内镜切除:日本视角。

IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Digestion Pub Date : 2025-01-01 Epub Date: 2025-02-12 DOI:10.1159/000543250
Yu Hashimoto, Syota Tomaru, Yuki Itoi, Keigo Sato, Hiroko Hosaka, Hirohito Tanaka, Shiko Kuribayashi, Yoji Takeuchi, Toshio Uraoka
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引用次数: 0

摘要

长期患有溃疡性结肠炎(UC)的患者有发生严重并发症的风险,称为UC相关瘤变(UCAN)。由于UCAN的治疗策略与散发性肿瘤有很大的不同,因此需要将UCAN与散发性肿瘤区分开来。本文综述了UC患者肿瘤病变的监测结肠镜检查(SC)和内镜下粘膜剥离(ESD)的现状和未来挑战。为了降低相关死亡率的风险,目前的指南建议在确认UC诊断后8-10年使用高清晰度结肠镜进行SC。然而,UCAN的内镜诊断有时具有挑战性,需要采用多种内镜方式逐步进行诊断。世界范围内的共识是,高度发育不良或更高级别的诊断是手术切除的指征。尽管低级别发育不良(LGD)的处理仍存在争议,但SCENIC共识声明建议完全切除“内镜下可切除”的LGD,然后进行监测。ESD是在日本发展起来的,可以去除复杂的胃肠道病变,促进LGD的治疗,并可以进行精确的病理评估,以区分UCAN和散发性肿瘤,并确定UCAN的不典型增生级别。在完成内镜切除后,应进行密切的内镜监测。日本专家共识会议建议在ESD完全切除后随访SC 6-12个月。未来需要前瞻性队列研究来更好地评估UC患者ESD的临床结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surveillance and Endoscopic Resection of Ulcerative Colitis-Associated Neoplasia: A Japanese Perspective.

Background: Patients with a long history of ulcerative colitis (UC) are at risk of developing a serious complication known as UC-associated neoplasia (UCAN). Because the treatment strategy for UCAN greatly differs from that for sporadic tumors, UCAN needs to be distinguished from sporadic tumors. This article provides an overview of the current status and future challenges regarding the surveillance colonoscopy (SC) and endoscopic submucosal dissection (ESD) of neoplastic lesions in patients with UC.

Summary: To reduce the risk of associated mortality, the current guidelines recommend initiating SC using chromoendoscopy with high-definition colonoscopy 8-10 years after the confirmation of a UC diagnosis. However, the endoscopic diagnosis of UCAN is occasionally challenging and requires a stepwise approach using multiple endoscopic modalities. The worldwide consensus is that a diagnosis of high-grade dysplasia or higher is an indication for proctocolectomy. Although the management of low-grade dysplasia (LGD) remains controversial, the SCENIC consensus statement recommends the complete removal of "endoscopically resectable" LGD, followed by monitoring. ESD was developed in Japan, allows for the removal of complex gastrointestinal lesions, facilitates the treatment of LGD, and enables precise pathological evaluations to differentiate between UCAN and sporadic tumors and to determine the grade of dysplasia in UCAN. Close endoscopic surveillance should follow complete endoscopic resection. A Japanese expert consensus meeting recommended the performance of follow-up SC 6-12 months after complete resection with ESD.

Key messages: The roles of ESD for UCAN are to treat LGD and to enable the histopathological examination of complete excisional biopsy specimens to differentiate between UCAN and sporadic tumors and grade the dysplasia of UCAN. In future, prospective cohort studies are needed to better assess the clinical outcomes of ESD in patients with UC.

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来源期刊
Digestion
Digestion 医学-胃肠肝病学
CiteScore
7.90
自引率
0.00%
发文量
39
审稿时长
6-12 weeks
期刊介绍: ''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.
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