Reappraising Risk Factors for Inflammatory Bowel Disease-associated Neoplasia: Implications for Colonoscopic Surveillance in IBD
Reappraising Risk Factors for Inflammatory Bowel Disease-associated Neoplasia: Implications for Colonoscopic Surveillance in IBD
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DOI：
10.1093/ecco-jcc/jjaa040
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发表时间：
2020-08-01
影响因子：
8
通讯作者：
Itzkowitz, Steven H.
中科院分区：
文献类型：
--
作者：
Shaha, Shailja C.;Itzkowitz, Steven H.
炎症性肠病[IBD]相关性结肠炎最可怕的并发症之一是结直肠癌。考虑到IBD患病率的大幅上升，而没有任何预期的下降，再加上异型增生的结肠切除率的下降和有效控制炎症的医疗选择的扩大，预计建议接受结肠镜检查以发现结直肠肿瘤的结肠炎患者和老年结肠炎性疾病患者池将使现有资源紧张，并挑战当前基于指南的监测建议的可持续性。与此同时，在一个被忽视为高危人群中，我们正在错过早期发现的机会，因为相当大一部分结直肠癌是在患有结肠性IBD的患者中诊断出来的，他们的病程短于指南建议的监测开始时。在这里，我们重新评估：1)炎症是考虑患者累积病程的动态风险因素；2)开始筛查的时间主要不是基于绝对病程；3)监测间隔作为基于单个患者因素和连续结肠镜检查结果的迭代确定。这一观点支持一种范式转变，这将在理想情况下导致IBD中更有效和更高价值的结直肠癌预防方法。
One of the most feared complications of inflammatory bowel disease [IBD]-associated colitis is colorectal cancer. When considering the substantial increase in the prevalence of IBD, without any anticipated decline, coupled with decreasing colectomy rates for dysplasia and expanding medical options for effectively controlling inflammation, it is predicted that the pool of people living with- and ageing with-colonic IBD, who are recommended to undergo lifelong colonoscopic surveillance for colorectal neoplasia, will strain existing resources and challenge the sustainability of current guideline-based surveillance recommendations. At the same time, we are missing the opportunity for early detection in a group that is overlooked as high-risk, as a substantial proportion of colorectal cancers are being diagnosed in individuals with colonic IBD who have disease duration shorter than when guidelines recommend surveillance initiation. Here, we reappraise: 1] inflammation as a dynamic risk factor that considers patients' cumulative course; 2] time of screening initiation that is not based primarily on absolute disease duration; and 3] surveillance intervals as an iterative determination based on individual patient factors and consecutive colonoscopic findings. This Viewpoint supports a paradigm shift that will ideally result in a more effective and higher-value colorectal cancer prevention approach in IBD.