Patients with long-standing inflammatory bowel disease (IBD) involving the colon are at higher risk of developing colorectal dysplastic or neoplastic lesions. While from sporadic colorectal cancer follows an “adenoma-carcinoma” sequence, IBD colitis-associated carcinogenesis is mainly related to an “inflammation-dysplasia-carcinoma” sequence. Currently, specific endoscopic surveillance strategies involving dye spray and virtual chromoendoscopy have been standardized, aiming for early CRC diagnosis. When detected, colitis-associated dysplasia should be classified according to standard classification, thus allowing for better treatment. Indeed, most IBD-associated dysplastic lesions can be treated with endoscopic resection, even though available procedures are usually more challenging than those in the general population. The higher frequency of severe submucosal fibrosis and the difficulty in the definition of lesions’ margins account for this issue. Current endoscopic resection techniques include polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Recent evidence suggests the relevance of en bloc resection, as this may be associated with lower rates of recurrence. Therefore, particularly for larger (>20 mm) lesions, ESD should be preferred, even though it is considered the most difficult technique due to frequent severe submucosal fibrosis. Considering the growing number of new endoscopic resective techniques, including underwater EMR or ESD, which in the general population have been suggested to lower procedure-related risks and may also allow a larger spread of advanced endoscopic resection in IBD. However, additional data are needed to assess the medium- and long-term efficacy of endoscopic resection of visible dysplasia in IBD patients, which are burdened by a high risk of local and, more importantly, metachronous recurrence.
长期患有累及结肠的炎症性肠病（IBD）患者发生结直肠异型增生或肿瘤性病变的风险更高。散发性结直肠癌遵循“腺瘤-癌”序列，而IBD结肠炎相关癌变则主要与“炎症-异型增生-癌”序列相关。目前，已标准化了涉及染料喷洒和虚拟色素内镜的特定内镜监测策略，旨在早期诊断结直肠癌。一旦发现，结肠炎相关异型增生应根据标准分类进行分级，以便更好地指导治疗。事实上，大多数IBD相关异型增生病变可通过内镜切除治疗，尽管现有操作通常比普通人群更具挑战性。这主要归因于严重黏膜下纤维化的高发生率以及病变边界界定的困难。当前的内镜切除技术包括息肉切除术、内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）。最新证据表明整块切除的重要性，因其可能与较低的复发率相关。因此，特别是对于较大（>20毫米）的病变，应优先考虑ESD，尽管由于频繁出现的严重黏膜下纤维化，该技术被认为是最具挑战性的。考虑到新兴内镜切除技术的不断增多，包括水下EMR或ESD，这些技术在普通人群中已被认为可降低手术相关风险，并可能促进IBD患者中高级内镜切除技术的更广泛应用。然而，仍需更多数据来评估IBD患者可见异型增生内镜切除的中长期疗效，因为这类患者不仅局部复发风险高，更重要的是存在异时性复发的高风险。
Colitis-Associated Dysplasia in Inflammatory Bowel Disease: Features and Endoscopic Management
肿瘤(癌症)患者之家