Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
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DOI：
10.1055/s-0034-1365348
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发表时间：
2014-05-01
期刊：
影响因子：
9.3
通讯作者：
East, James E.
中科院分区：
文献类型：
--
作者：
Kaminski, Michal F.;Hassan, Cesare;East, James E.
本指南是欧洲胃肠内镜学会（ESGE）的官方声明。主要说明1 ESGE建议常规使用高清晰度白光内窥镜系统检测平均风险人群中的结直肠肿瘤（弱推荐，中等质量证据）。2 ESGE建议常规使用高清系统和全结肠常规或虚拟（窄带成像[NBI]，i-SCAN）色素内镜在已知或疑似Lynch综合征患者中的应用（强烈建议，低质量证据）。2bESGE建议在已知或疑似锯齿状息肉综合征患者中常规使用高清晰度系统和全结肠常规或虚拟（NBI）色素内镜检查（强烈建议，低质量证据）。3ESGE建议在长期结肠炎患者中常规使用 0.1%亚甲蓝或 0.1% - 0.5% 靛蓝胭脂红全结肠染色内镜检查，并进行靶向活检，以监测肿瘤形成。在经过适当培训的人员中，在静止疾病活动和充分肠道准备的情况下，可以放弃非靶向四象限活检（强烈建议，高质量证据）。4 ESGE建议在严格控制的条件下，虚拟色素内镜（NBI，FICE，i-SCAN）和传统色素内镜可用于实时光学诊断小型（≤ 5 mm）结直肠息肉，以取代组织病理学诊断。 光学诊断必须使用经过验证的量表进行报告，必须有充分的照片记录，并且只能由经过充分培训和审核的经验丰富的内窥镜医生进行（弱推荐，高质量证据）。5ESGE建议使用常规或虚拟（NBI）放大色素内镜来预测浸润性癌和病变（如凹陷部分）中深层粘膜下浸润的风险（0-IIc根据巴黎分类）或非颗粒或混合型横向扩散性肿瘤（弱推荐，中等质量的证据）.ConclusionAdvanced imaging techniques will need to be applied in specific patient groups in routine clinical practice and to be teached in endoscopic training programs.
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the role of advanced endoscopic imaging for the detection and differentiation of colorectal neoplasia.Main recommendations1ESGE suggests the routine use of high definition white-light endoscopy systems for detecting colorectal neoplasia in average risk populations (weak recommendation, moderate quality evidence).2ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (narrow band imaging [NBI], i-SCAN) chromoendoscopy in patients with known or suspected Lynch syndrome (strong recommendation, low quality evidence).2bESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (NBI) chromoendoscopy in patients with known or suspected serrated polyposis syndrome (strong recommendation, low quality evidence).3ESGE recommends the routine use of 0.1 % methylene blue or 0.1 % – 0.5 % indigo carmine pancolonic chromoendoscopy with targeted biopsies for neoplasia surveillance in patients with long-standing colitis. In appropriately trained hands, in the situation of quiescent disease activity and adequate bowel preparation, nontargeted, four-quadrant biopsies can be abandoned (strong recommendation, high quality evidence).4ESGE suggests that virtual chromoendoscopy (NBI, FICE, i-SCAN) and conventional chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained and audited (weak recommendation, high quality evidence).5ESGE suggests the use of conventional or virtual (NBI) magnified chromoendoscopy to predict the risk of invasive cancer and deep submucosal invasion in lesions such as those with a depressed component (0-IIc according to the Paris classification) or nongranular or mixed-type laterally spreading tumors (weak recommendation, moderate quality evidence).ConclusionAdvanced imaging techniques will need to be applied in specific patient groups in routine clinical practice and to be taught in endoscopic training programs.