Pouchitis atlas for objective endoscopic diagnosis
Pouchitis atlas for objective endoscopic diagnosis
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DOI：
10.1007/s00535-007-2083-3
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发表时间：
2007-10-01
影响因子：
6.3
通讯作者：
Sasaki, Iwao
中科院分区：
文献类型：
--
作者：
Fukushima, Kouhei;Fujii, Hisao;Sasaki, Iwao
“结肠袋炎”是溃疡性结肠炎全直肠结肠切除术和回肠结肠袋-肛门吻合术后结肠袋的非特异性粘膜炎症的术语。盆腔袋炎是盆腔袋最常见的晚期并发症。为了提高结肠袋炎诊断的准确性，之前已经评估了临床症状和内窥镜检查结果（有或没有活检样本的组织学）。内窥镜检查结果是诊断的核心，对各种内窥镜检查结果达成普遍共识必须是客观诊断结肠袋炎的第一步。由于结肠袋炎的内镜评价缺乏一个适当的路标，我们开发了这个结肠袋炎图谱，以尽量减少个别内镜医师之间固有的诊断差异。我们还提出了新的诊断结肠袋炎的标准：日本结肠袋炎的诊断标准。这些标准是基于临床症状和内镜检查结果，在图谱中明确分类，并排除感染性肠炎，吻合口功能不全，盆腔感染，肛门功能障碍和克罗恩病。新标准的优点包括易于床旁诊断，无需计算其他袋炎标准所需的分数。这个结肠袋炎图谱，连同我们的新标准，应该有助于建立一个明确的诊断结肠袋炎，并促进更好地评估和治疗这种新的肠道炎症。
"Pouchitis" is a term for nonspecific mucosal inflammation of the pouch after total proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis. Pouchitis is the most frequent complication of the pelvic pouch at the late stage. To improve the accuracy of the pouchitis diagnosis, sets of clinical symptoms and endoscopic findings (with or without histology of biopsy samples) have previously been evaluated. Endoscopic findings are central to the diagnosis, and a universal consensus of various endoscopic findings must be the initial step toward an objective diagnosis of pouchitis. Since a proper signpost for the endoscopic evaluation of pouchitis has been absent, we developed this pouchitis atlas to minimize the diagnostic variation inherent among individual endoscopists. We also propose new criteria for the diagnosis of pouchitis: the Japanese criteria for diagnosis of pouchitis. These criteria are based on clinical symptoms and endoscopic findings that are clearly categorized in the atlas, and exclude infectious enteritis, anastomotic insufficiency, pelvic infection, anal dysfunction, and Crohn's disease. Advantages of the new criteria include ease of bedside diagnosis, without the calculation of points required by the other criteria for pouchitis. This pouchitis atlas, together with our new criteria, should contribute to the establishment of a clear-cut diagnosis for pouchitis and promote better evaluation and treatment of this novel intestinal inflammation.