Strategische Konzepte bei Diagnostik und Therapie von Dysplasien bei chronisch entzündlichen Darmerkrankungen
Publisher：
Karger
E-ISSN：
2297-475x|18|2|148-154
ISSN：
2297-4725
Source：
Visceral Medicine (formerly: Viszeralmedizin),
Vol.18,
Iss.2, 2002-07,
pp. : 148-154
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Abstract
Diagnostics and Therapy of Dysplasias in Chronic Inflammatory Bowel Diseases Patients with inflammatory bowel disease are at increased (about 4- to 10-fold) risk for developing carcinoma. The risk for colorectal cancer in patients with ulcerative colitis depends on the duration, extension and severity of disease, age at onset of the disease, and the existence of a coincident primary sclerosing cholangitis as well as backwash ileitis. In patients with Crohn’s disease, chronic inflammation of the colon is probably the most important risk factor for the development of colorectal cancer. A significant predictor for the risk of malignancy in patients with inflammatory bowel disease is the presence of dysplasia. Since molecular markers are not yet reliable indicators for malignancy, guidelines for surveillance are based on the diagnosis of dysplastic lesions. New methods (e.g. chromoendoscopy, endoscopic fluorescence detection, immunoscopy) to improve the detection of premalignant and malignant lesions are under evaluation. So far, the standard biopsy protocol for patients with inflammatory bowel disease includes biopsies in the 4 quadrants every 10 cm, and careful biopsy also should be performed on any strictured, raised, or velvety-appearing mucosa. Most guidelines recommend that colonoscopy surveillance should begin 8 years after the onset of pancolitis, and 15 years after the onset of left-sided colitis. Patients with extensive Crohn’s colitis should be included in surveillance programs according to the guidelines for ulcerative colitis. After histological confirmation of dysplasia in association with a mass lesion (DALM) or the detection of multiple dysplastic areas, colectomy is strongly recommended. In case of detection of a single low-grade dysplasia in a macroscopic normalappearing mucosa a control endoscopy after 3 months should be performed. Patients should undergo colectomy when the presence of dysplasia is confirmed.
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