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Only for medical professionals to read for reference.
From diagnosis, treatment to monitoring, we will teach you step by step.
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD).
The risk of colorectal cancer (CRC) in IBD patients, especially UC patients, increases with the length of the disease (2% in the 10th year, 8% in the 20th year, and 18% in the 30th year).
Other risk factors for CRC mainly include: wide range of inflammatory lesions, long illness time, young age at diagnosis, combined with primary sclerosing cholangitis (the risk of CRC increased by 4 times), family history of colorectal cancer, high inflammatory activity, Flat lesions and multiple lesions.
The risk of severe dysplasia (HGD) is higher than that of mild dysplasia (LGD).
So, when IBD patients with colonic proliferative lesions, what kind of countermeasures should be taken clinically? In 2021, Digestive Disease Week (DDW) in the United States has arranged a topic lecture on the treatment of IBD patients with colonic hyperplastic disease, and discussed the treatment measures for such patients, the corresponding use timing and precautions.
"Digestive Liver Disease Channel of the Medical Circle" specially invited Dr.
Mingjia Xi from the Department of Gastroenterology, West China Hospital of Sichuan University to bring us wonderful conference reports.
Diagnosis of IBD complicated with colonic hyperplastic lesions At present, most scholars believe that colorectal cancer in IBD patients mainly originates from the dysplasia of the intestinal epithelium.
The discovery of dysplasia lesions relies on endoscopic mucosal biopsy, including targeted biopsy and random biopsy.
A previous study statistically analyzed the pathological results of IBD patients after colectomy, and found that the missed diagnosis rate of HGD or CRC lesions was 29%, and this data has not changed significantly in the past 20 years.
Professor Marietta Lacucci shared with us the 5 "S" criteria for endoscopic reporting of colonic hyperplastic lesions in IBD patients proposed in the European Crohn's and Colitis Organization (ECCO) guidelines in 2021.
The standardized endoscopy report helps clinicians to accurately judge the patient's condition and provide a basis for the choice of treatment methods.
1.
Shape: polypoid, non-polypoid or lateral growth tumor, whether the edge of the lesion is regular and whether there is ulcer; 2.
Size: can use the biopsy forceps as a reference to accurately describe the size of the lesion; 3.
Site: the area related to colitis, Non-colitis related areas; 4.
Surface: Kudo pit pattern classification or FACILE classification; 5.
Surrounding: Whether it is an active area of colitis, and whether there are other lesions around it.
Treatment of IBD combined with colonic hyperplasia lesions Indications for endoscopic treatment of IBD combined with colonic hyperplasia lesions: 1.
Over 50 years old (considering the risk of metachronous lesions, young patients are not suitable for ESD); 2.
Colonoscopy shows IBD patients are in remission (Mayo score is 0 or 1); 3.
Patients with primary sclerosing cholangitis (have a higher risk of colorectal cancer); 4.
Lesion features: single lesion with diameter> 10mm, lesion The boundary is clear and non-depressed, non-VN-type lesions (surface pattern); 5.
Pathological features: mild to severe dysplasia, sessile serrated adenoma/polyps with/without dysplasia, en bloc resection, highly differentiated Type colon cancer with an infiltration depth of less than 1000μm, (non-indications: signet ring cell carcinoma and poorly differentiated carcinoma).
The main treatment methods for patients with IBD and colorectal dysplasia include: snare resection, EMR, ESD and surgery.
Patients need to have a multidisciplinary team (MDT) discussion before treatment, and a treatment plan will be jointly developed by IBD specialists, endoscopists, gastrointestinal surgeons, radiologists, pathologists, etc.
Small lesions without fibrosis can be removed by EMR, while lesions with a diameter of more than 20 mm and fibrosis require ESD treatment.
The fibrosis of the colonic submucosa of IBD patients increases the difficulty of ESD surgery, so experienced and skilled endoscopists are required for endoscopic treatment.
In addition, Professor Marietta Lacucci compared the advantages and disadvantages of EMR and ESD: the pointers of surgical operation for IBD combined with colonic hyperplasia: 1.
The lesion cannot be removed endoscopically; 2.
There are residual dysplasia lesions at the base of the endoscopically resected tissue 3.
Random biopsy revealed dysplasia lesions not found under endoscopy; 4.
Multiple dysplasia lesions.
A single-center study by Professor Emre Gorgun in Cleveland revealed that ESD is a safe and effective treatment.
The study included 7 patients, of which 85.
7% achieved en bloc resection, and only one case received additional surgery.
All patients had no complications of perforation or obvious bleeding, and no recurrence occurred during the colonoscopy follow-up within 6 postoperatively.
Follow-up of IBD with colonic hyperplasia, Professor Emre Gorgun pointed out that the implementation of effective secondary prevention measures (colonoscopy follow-up) and primary prevention (drugs to control intestinal inflammation) can help reduce the risk of colorectal cancer.
ECCO 2019 pointed out that it is necessary to stratify patients according to the specific conditions of the patients, according to the level of CRC risk, and develop an individualized follow-up plan.
Patients need to start regular colonoscopy follow-up at 8 years after diagnosis of UC or when primary sclerosing cholangitis (PSC) appears.
Expert profile Dr.
Hu Zhang (University of Cambridge), Professor/Chief Physician, Assistant to the Dean of West China Hospital of Sichuan University, Deputy Director of the Center for Inflammatory Bowel Disease, West China Hospital of Sichuan University, Inflammatory Bowel Disease Research Laboratory, Center for Frontier Science of Molecular Network of Diseases, Sichuan University deputy director.
Educational experience: Graduated from the Department of Clinical Medicine, West China University of Medical Sciences, and worked with Professor Ouyang Qin in Inflammatory Bowel Disease.
After 5 years of working in the university after master's degree, he went to Cambridge University to study for PhD and studied under the internationally renowned IBD expert Dr Miles Parkes.
(Rotating Chairman of the International IBD Genetic Research Collaboration Group), after graduation, he returned to West China to continue to engage in IBD clinical and scientific research. Academic position: Member of the Inflammatory Bowel Disease Group of the Chinese Medical Association Gastroenterology Branch, Member of the Standing Committee of the Wu Jieping Foundation Inflammatory Bowel Disease Alliance, Member of the Chinese Inflammatory Bowel Disease Expert Committee, Academic Leader of the Sichuan Provincial Health Commission, Sichuan Provincial Science and Technology Reserve candidates for technical leaders.
Scientific research and academic achievements: Responsible for presiding over a number of national, provincial and ministerial scientific research projects such as the National Natural Science Foundation of China.
So far, there are more than 40 SCI papers, including one and more than 20 newsletters, such as the first published work in Gastroenterology, and the newsletter published in AJG and JCC.
He has cited more than 3000 times and 1 ESI highly cited paper.
He is an international reviewer for the fund application projects of the Netherlands Health Research and Development Organization and the Kazakhstan Science and Technology Review Center; the editorial board of many SCI journals; the assistant editor-in-chief of the Oxford University Press journal Precision Clinical Medicine; currently there are more than 20 international journals Specially invited reviewers of clinical medical journals such as NEJM, AJG, etc.
Editor-in-chief of a monograph "The Pathogenesis of Digestive System Diseases and New Progress in Clinical Diagnosis and Treatment", and participated in the compilation of many monographs.
References: [1]Michel A,Roger F,Marietta I,et al.
ECCO Topical Review Optimising reporting in surgery,endoscopy,and histopathology.
Journal of Crohn's and Colitis,2021.
[2]Loren,Laine,Tonya,et al .
SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease.
Gastrointestinal Endoscopy,2015,81(3):489-501.
e26.
[3]Shergill AK,Lightdale JR,Bruining DH,et al.
The role of endoscopy in inflammatory bowel disease.
Gastrointestinal endoscopy,2015,81(5):1101-1121.
e13.
[4]Christian M,Andreas S,Vavricka SR,et al.
ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1:Initial diagnosis,monitoring of known IBD,detection of complications.
Journal of Crohn's and Colitis,2018(2):2.
From diagnosis, treatment to monitoring, we will teach you step by step.
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD).
The risk of colorectal cancer (CRC) in IBD patients, especially UC patients, increases with the length of the disease (2% in the 10th year, 8% in the 20th year, and 18% in the 30th year).
Other risk factors for CRC mainly include: wide range of inflammatory lesions, long illness time, young age at diagnosis, combined with primary sclerosing cholangitis (the risk of CRC increased by 4 times), family history of colorectal cancer, high inflammatory activity, Flat lesions and multiple lesions.
The risk of severe dysplasia (HGD) is higher than that of mild dysplasia (LGD).
So, when IBD patients with colonic proliferative lesions, what kind of countermeasures should be taken clinically? In 2021, Digestive Disease Week (DDW) in the United States has arranged a topic lecture on the treatment of IBD patients with colonic hyperplastic disease, and discussed the treatment measures for such patients, the corresponding use timing and precautions.
"Digestive Liver Disease Channel of the Medical Circle" specially invited Dr.
Mingjia Xi from the Department of Gastroenterology, West China Hospital of Sichuan University to bring us wonderful conference reports.
Diagnosis of IBD complicated with colonic hyperplastic lesions At present, most scholars believe that colorectal cancer in IBD patients mainly originates from the dysplasia of the intestinal epithelium.
The discovery of dysplasia lesions relies on endoscopic mucosal biopsy, including targeted biopsy and random biopsy.
A previous study statistically analyzed the pathological results of IBD patients after colectomy, and found that the missed diagnosis rate of HGD or CRC lesions was 29%, and this data has not changed significantly in the past 20 years.
Professor Marietta Lacucci shared with us the 5 "S" criteria for endoscopic reporting of colonic hyperplastic lesions in IBD patients proposed in the European Crohn's and Colitis Organization (ECCO) guidelines in 2021.
The standardized endoscopy report helps clinicians to accurately judge the patient's condition and provide a basis for the choice of treatment methods.
1.
Shape: polypoid, non-polypoid or lateral growth tumor, whether the edge of the lesion is regular and whether there is ulcer; 2.
Size: can use the biopsy forceps as a reference to accurately describe the size of the lesion; 3.
Site: the area related to colitis, Non-colitis related areas; 4.
Surface: Kudo pit pattern classification or FACILE classification; 5.
Surrounding: Whether it is an active area of colitis, and whether there are other lesions around it.
Treatment of IBD combined with colonic hyperplasia lesions Indications for endoscopic treatment of IBD combined with colonic hyperplasia lesions: 1.
Over 50 years old (considering the risk of metachronous lesions, young patients are not suitable for ESD); 2.
Colonoscopy shows IBD patients are in remission (Mayo score is 0 or 1); 3.
Patients with primary sclerosing cholangitis (have a higher risk of colorectal cancer); 4.
Lesion features: single lesion with diameter> 10mm, lesion The boundary is clear and non-depressed, non-VN-type lesions (surface pattern); 5.
Pathological features: mild to severe dysplasia, sessile serrated adenoma/polyps with/without dysplasia, en bloc resection, highly differentiated Type colon cancer with an infiltration depth of less than 1000μm, (non-indications: signet ring cell carcinoma and poorly differentiated carcinoma).
The main treatment methods for patients with IBD and colorectal dysplasia include: snare resection, EMR, ESD and surgery.
Patients need to have a multidisciplinary team (MDT) discussion before treatment, and a treatment plan will be jointly developed by IBD specialists, endoscopists, gastrointestinal surgeons, radiologists, pathologists, etc.
Small lesions without fibrosis can be removed by EMR, while lesions with a diameter of more than 20 mm and fibrosis require ESD treatment.
The fibrosis of the colonic submucosa of IBD patients increases the difficulty of ESD surgery, so experienced and skilled endoscopists are required for endoscopic treatment.
In addition, Professor Marietta Lacucci compared the advantages and disadvantages of EMR and ESD: the pointers of surgical operation for IBD combined with colonic hyperplasia: 1.
The lesion cannot be removed endoscopically; 2.
There are residual dysplasia lesions at the base of the endoscopically resected tissue 3.
Random biopsy revealed dysplasia lesions not found under endoscopy; 4.
Multiple dysplasia lesions.
A single-center study by Professor Emre Gorgun in Cleveland revealed that ESD is a safe and effective treatment.
The study included 7 patients, of which 85.
7% achieved en bloc resection, and only one case received additional surgery.
All patients had no complications of perforation or obvious bleeding, and no recurrence occurred during the colonoscopy follow-up within 6 postoperatively.
Follow-up of IBD with colonic hyperplasia, Professor Emre Gorgun pointed out that the implementation of effective secondary prevention measures (colonoscopy follow-up) and primary prevention (drugs to control intestinal inflammation) can help reduce the risk of colorectal cancer.
ECCO 2019 pointed out that it is necessary to stratify patients according to the specific conditions of the patients, according to the level of CRC risk, and develop an individualized follow-up plan.
Patients need to start regular colonoscopy follow-up at 8 years after diagnosis of UC or when primary sclerosing cholangitis (PSC) appears.
Expert profile Dr.
Hu Zhang (University of Cambridge), Professor/Chief Physician, Assistant to the Dean of West China Hospital of Sichuan University, Deputy Director of the Center for Inflammatory Bowel Disease, West China Hospital of Sichuan University, Inflammatory Bowel Disease Research Laboratory, Center for Frontier Science of Molecular Network of Diseases, Sichuan University deputy director.
Educational experience: Graduated from the Department of Clinical Medicine, West China University of Medical Sciences, and worked with Professor Ouyang Qin in Inflammatory Bowel Disease.
After 5 years of working in the university after master's degree, he went to Cambridge University to study for PhD and studied under the internationally renowned IBD expert Dr Miles Parkes.
(Rotating Chairman of the International IBD Genetic Research Collaboration Group), after graduation, he returned to West China to continue to engage in IBD clinical and scientific research. Academic position: Member of the Inflammatory Bowel Disease Group of the Chinese Medical Association Gastroenterology Branch, Member of the Standing Committee of the Wu Jieping Foundation Inflammatory Bowel Disease Alliance, Member of the Chinese Inflammatory Bowel Disease Expert Committee, Academic Leader of the Sichuan Provincial Health Commission, Sichuan Provincial Science and Technology Reserve candidates for technical leaders.
Scientific research and academic achievements: Responsible for presiding over a number of national, provincial and ministerial scientific research projects such as the National Natural Science Foundation of China.
So far, there are more than 40 SCI papers, including one and more than 20 newsletters, such as the first published work in Gastroenterology, and the newsletter published in AJG and JCC.
He has cited more than 3000 times and 1 ESI highly cited paper.
He is an international reviewer for the fund application projects of the Netherlands Health Research and Development Organization and the Kazakhstan Science and Technology Review Center; the editorial board of many SCI journals; the assistant editor-in-chief of the Oxford University Press journal Precision Clinical Medicine; currently there are more than 20 international journals Specially invited reviewers of clinical medical journals such as NEJM, AJG, etc.
Editor-in-chief of a monograph "The Pathogenesis of Digestive System Diseases and New Progress in Clinical Diagnosis and Treatment", and participated in the compilation of many monographs.
References: [1]Michel A,Roger F,Marietta I,et al.
ECCO Topical Review Optimising reporting in surgery,endoscopy,and histopathology.
Journal of Crohn's and Colitis,2021.
[2]Loren,Laine,Tonya,et al .
SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease.
Gastrointestinal Endoscopy,2015,81(3):489-501.
e26.
[3]Shergill AK,Lightdale JR,Bruining DH,et al.
The role of endoscopy in inflammatory bowel disease.
Gastrointestinal endoscopy,2015,81(5):1101-1121.
e13.
[4]Christian M,Andreas S,Vavricka SR,et al.
ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1:Initial diagnosis,monitoring of known IBD,detection of complications.
Journal of Crohn's and Colitis,2018(2):2.
