Is routine pouch surveillance for dysplasia indicated for ileoanal pouches?
Is routine pouch surveillance for dysplasia indicated for ileoanal pouches?
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DOI：
10.1007/s10350-004-6517-1
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发表时间：
2003-02-01
影响因子：
3.9
通讯作者：
Schoetz, DJ
中科院分区：
文献类型：
--
作者：
Herline, AJ;Meisinger, LL;Schoetz, DJ
目的：肿瘤性肛袋变的孤立报道提示有必要进行常规回肠肛袋监测和活检。这些报道暗示了一种从异型增生到癌变的膀胱粘膜模型。最近研究“高危”溃疡性结肠炎患者的报告得出结论，膀胱型异型增生的发展确实是一种罕见的事件。这项研究旨在评估我们在长期随访期间回肠肛袋异型增生的发生率。方法：查询1983-2001年间所有接受回肠肛囊术的患者(n=767)的前瞻性数据库。所有行囊活检的溃疡性结肠炎患者均纳入研究对象。这排除了克罗恩病、不明原因结肠炎和家族性腺瘤性息肉病的患者。对病理报告进行回顾，以寻找炎症、非典型性、化生、异型增生或癌症的组织学证据。分析患者活检时的年龄、活检时的眼袋年龄和病理。结果：共对160例患者回肠肛囊进行活检222次。平均随访时间为8.4+/-4.6年。在监测时，83名患者(52%)的眼袋年龄超过10岁(平均12.7+/-2岁)，超过1800年的眼袋监测，只有1例患者的眼袋内有局灶性、低级别的异型增生，这名患者在进一步的监测中没有表现出异型增生的证据。结论：即使对回肠肛袋患者进行长期随访，也没有证据支持溃疡性结肠炎患者进行常规的回肠粘膜活检。
PURPOSE: Isolated accounts of neoplastic pouch transformation suggest the need to perform routine ileoanal pouch surveillance with biopsy. These reports imply a model of dysplasia to cancer transformation of the pouch mucosa. More recent reports studying "high risk" ulcerative colitis patients concluded that the development of pouch dysplasia is indeed a rare event. This study was designed to evaluate our institutional incidence of dysplasia in ileoanal pouch during long-term follow-up. METHODS: A prospective database of all patients undergoing ileoanal pouch construction (n = 767) was queried for all patients undergoing pouch biopsy between 1983 and 2001. All patients with ulcerative colitis who underwent pouch biopsy were included. This excluded patients with Crohn's disease, indeterminate colitis, and familial adenomatous polyposis. Pathology reports were reviewed for histologic evidence of inflammation, atypia, metaplasia, dysplasia, or cancer. Patient age at biopsy, pouch age at time of biopsy, and pathology were analyzed. RESULTS: The ileoanal pouches of 160 patients were surveyed with biopsies a total of 222 times. The average length of follow-up from pouch construction to time of surveillance and biopsy was 8.4 +/- 4.6 years. There were 83 patients (52 percent) whose pouches were older than 10 years (mean, 12.7 +/- 2) at time of surveillance, With over 1,800 pouch-years of surveillance, only 1 patient had focal, low-grade dysplasia in the pouch, This patient demonstrated no evidence of dysplasia on further surveillance. CONCLUSION: Even with long-term follow-up of ileoanal pouch patients, there is little evidence to support routine biopsy of the ileal mucosa in ulcerative colitis patients.