18 - World Journal of Gastroenterology
18 - World Journal of Gastroenterology
18 - World Journal of Gastroenterology
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PO Box 2345, Beijing 100023, China <strong>World</strong> J Gastroenterol 2007 May 14; 13(<strong>18</strong>): 2523-2528<br />
www.wjgnet.com <strong>World</strong> <strong>Journal</strong> <strong>of</strong> <strong>Gastroenterology</strong> ISSN 1007-9327<br />
wjg@wjgnet.com © 2007 The WJG Press. All rights reserved.<br />
Magnifying chromoscopy, a novel and useful technique for<br />
colonoscopy in ulcerative colitis<br />
Takafumi Ando, Hironao Takahashi, Osamu Watanabe, Osamu Maeda, Kazuhiro Ishiguro, Daisuke Ishikawa,<br />
Mot<strong>of</strong>usa Hasegawa, Naoki Ohmiya, Yasumasa Niwa, Hidemi Goto<br />
Takafumi Ando, Hironao Takahashi, Osamu Watanabe,<br />
Osamu Maeda, Kazuhiro Ishiguro, Daisuke Ishikawa,<br />
Mot<strong>of</strong>usa Hasegawa, Naoki Ohmiya, Yasumasa Niwa, Hidemi<br />
Goto, Department <strong>of</strong> <strong>Gastroenterology</strong>, Nagoya University<br />
Graduate School <strong>of</strong> Medicine, Nagoya, Japan<br />
Correspondence to: Dr. Takafumi Ando, Department <strong>of</strong><br />
<strong>Gastroenterology</strong>, Nagoya University Graduate School <strong>of</strong><br />
Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550<br />
Japan. takafumia-gi@umin.ac.jp<br />
Telephone: +81-52-7442144 Fax: +81-52-7442175<br />
Received: 2007-04-11 Accepted: 2007-04-30<br />
Abstract<br />
Ulcerative colitis (UC) is a chronic inflammatory bowel<br />
disorder characterized by exacerbations and remissions.<br />
The degree <strong>of</strong> inflammation as assessed by conventional<br />
colonoscopy is a reliable parameter <strong>of</strong> disease activity.<br />
However, even when conventional colonoscopy suggests<br />
remission and normal mucosal findings, microscopic<br />
abnormalities may persist, and relapse may occur<br />
later. Patients with long-standing, extensive ulcerative<br />
colitis have an increased risk <strong>of</strong> developing colorectal<br />
cancer. Ulcerative colitis-associated colorectal cancer<br />
is characterized by an early age at onset, poorly<br />
differentiated tumor cells, mucinous carcinoma, and<br />
multiple lesions. Early detection <strong>of</strong> dysplasia and colitic<br />
cancer is thus a prerequisite for survival. A relatively<br />
new method, magnifying chromoscopy, is thought to be<br />
useful for the early detection and diagnosis <strong>of</strong> dysplasia<br />
and colitic cancer, as well as the prediction <strong>of</strong> relapse.<br />
© 2007 The WJG Press. All rights reserved.<br />
Key words: Ulcerative colitis; Histopathology; Conventional<br />
colonoscopy; Magnifying colonoscopy; Ulcerative colitisassociated<br />
colorectal cancer<br />
Ando T, Takahashi H, Watanabe O, Maeda O, Ishiguro<br />
K, Ishikawa D, Hasegawa M, Ohmiya N, Niwa Y, Goto H.<br />
Magnifying chromoscopy, a novel and useful technique<br />
for colonoscopy in ulcerative colitis. <strong>World</strong> J Gastroenterol<br />
2007; 13(<strong>18</strong>): 2523-2528<br />
http://www.wjgnet.com/1007-9327/13/2523.asp<br />
INTRODUCTION<br />
The degree <strong>of</strong> inflammation in �l�erati�e �l�erati�e l�erati�e ati�e ti�e �oliti�� �oliti�� �oliti�� �oliti�� �oliti�� ����� ����� ����� ����� ����� �����<br />
EDITORIAL<br />
a�� a����e����ed by �on�entional �olono���opy i�� a reliable<br />
parameter <strong>of</strong> di��ea��e a�ti�ity.� ��en ��en �en �hen �hen �hen �on�entional<br />
�on�entional<br />
�on�entional<br />
�olono���opy ���gge��t�� remi����ion and normal m��o��al<br />
finding���� ���� �� ho�e�er�� ho�e�er�� ho�e�er�� ho�e�er�� mi�ro���opi� mi�ro���opi� mi�ro���opi� mi�ro���opi� mi�ro���opi� abnormalitie�� abnormalitie�� abnormalitie�� abnormalitie�� abnormalitie�� abnormalitie�� may<br />
may<br />
may<br />
per��i��t [����� �������� and relap��e may o���r later [�� ��� .� �� �� i�� i�� i�� a �hroni� �hroni� �hroni�<br />
di��ea��e �ith an �nkno�n �a���e �hara�teri�ed �hara�teri�ed by diff���e diff���e diff���e<br />
m��o��al inflammation <strong>of</strong> the �olore�t�m and a �o�r��e �o�r��e<br />
<strong>of</strong> e�a�erbation�� e�a�erbation�� and remi����ion�� remi����ion�� [���� ����� .� The he p�rpo��e p�rpo��e p�rpo��e <strong>of</strong><br />
treatment in patient�� patient�� patient�� �ith �ith �ith �� �� �� �� i�� i�� i�� i�� i�� th��� th��� th��� th��� th��� th��� the the a�hie�ement a�hie�ement a�hie�ement a�hie�ement a�hie�ement a�hie�ement <strong>of</strong><br />
<strong>of</strong><br />
remi����ion and maintenan�e enan�e <strong>of</strong> ��ie���en�e.� ��ie���en�e.� ��ie���en�e.� �n �n �n �n important<br />
fa�tor in �hoo��ing treatment method�� i�� the e�al�ation e�al�ation ion<br />
<strong>of</strong> di��ea��e di��ea��e a�ti�ity�� a�ti�ity���� thi�� thi�� thi�� thi�� thi�� i�� i�� i�� i�� i�� �ommonly �ommonly �ommonly �ommonly �ommonly done done ���ing ���ing ���ing ���ing ���ing �lini�al �lini�al �lini�al �lini�al �lini�al �lini�al<br />
�riteria ba��ed on ��ymptom�� [9�� o�ing o�ing to it�� it�� �on�enien�e<br />
�on�enien�e<br />
�on�enien�e �e<br />
and nonin�a��i�ene����.� ne����.� .� �hen �hen �hen �hen hen �lini�al �lini�al �lini�al �lini�al �lini�al �riteria �riteria �riteria �riteria �riteria are are ���ed ���ed ���ed ���ed ���ed<br />
alone�� �� ho�e�er�� ho�e�er�� ho�e�er�� ho�e�er�� ���� ���� ���� ���� ���� <strong>of</strong> <strong>of</strong> patient�� patient�� patient�� patient�� patient�� in in �hom �hom �hom �hom �hom remi����ion remi����ion remi����ion remi����ion remi����ion i�� i�� i�� i�� i��<br />
a�hie�ed relap��e �ithin � year [������� �������� .� ����� ����� �������� �������� ���������� ����������<br />
the need for �olono���opi� �olono���opi� and hi��topathologi� hi��topathologi� a����e����ment a����e����ment<br />
al��o���� not�ith��tanding not�ith��tanding not�ith��tanding not�ith��tanding their their di��ad�antage���� di��ad�antage���� di��ad�antage���� di��ad�antage���� di��ad�antage���� �� in�l�ding in�l�ding in�l�ding in�l�ding in�l�ding in�l�ding in�l�ding in�l�ding<br />
in�on�enien�e�� in�a��i�ene���� and prolongation <strong>of</strong> the<br />
�olono���opi� e�amination.�<br />
Patient�� �ith long���tanding �� �� are kno�n kno�n kno�n to ha�e ha�e ha�e an<br />
in�rea��ed ri��k for the de�elopment <strong>of</strong> �olore�tal �an�er.�<br />
�ltho�gh ��ome in�e��tigator�� in�e��tigator�� re�ommend re�ommend re�ommend prophyla�ti� prophyla�ti� prophyla�ti� prophyla�ti� �ti� total<br />
total<br />
pro�to�ole�tomy for the��e high�ri��k patient���� ���r�eillan�e ���r�eillan�e<br />
�olono���opy to dete�t ���a����o�iated �olore�tal �an�er<br />
i�� generally performed in��tead.� �ltho�gh �ltho�gh ���a����o�iated<br />
���a����o�iated<br />
���a����o�iated<br />
dy��pla��ia i�� i�� �on��idered �on��idered �on��idered a ���ef�l ���ef�l ���ef�l marker <strong>of</strong> <strong>of</strong> �olore�tal �olore�tal �olore�tal �olore�tal �olore�tal �an�er �an�er �an�er �an�er �an�er<br />
at ���r�eillan�e �olono���opy�� re�ognition re�ognition <strong>of</strong> dy��pla��ia�� dy��pla��ia��<br />
p�r���ul�rly� ���� ���� �y���pl������� �y���pl������� �� ��� ��� ��� ���p�r�� ���p�r�� ���p�r�� �y� �y� �y� ��� ��� ��� �������������<br />
��������������<br />
�������������<br />
�������������<br />
ind��ed gran�lar gran�lar �hange�� �hange�� �hi�h �hi�h �hi�h ari��e ari��e ari��e in ba�kgro�nd ba�kgro�nd ba�kgro�nd ba�kgro�nd<br />
m��o��a.� �t �t t i�� i�� i�� therefore therefore generally generally re�ommended re�ommended re�ommended re�ommended re�ommended that<br />
that<br />
that<br />
biop��y ��pe�imen�� be taken e�ery e�ery e�ery �� �� �� �m �m �m �m �m along along the the �hole �hole �hole �hole �hole �hole �hole<br />
�olore�t�m [��� ���� .� ��en ��en �ith �ith thi�� thi�� thi�� thi�� �o�erage�� �o�erage�� �o�erage�� �o�erage�� ho�e�er�� ho�e�er�� ho�e�er�� ho�e�er�� o�e�er���� a a ��et ��et ��et ��et ��et ��et ��et<br />
<strong>of</strong> �� biop��y ��pe�imen�� ha�� ha�� been theoreti�ally theoreti�ally theoreti�ally �al��lated �al��lated �al��lated<br />
to repre��ent repre��ent only �.����� �.����� �.����� <strong>of</strong> <strong>of</strong> the the total total ���rfa�e ���rfa�e ���rfa�e area area <strong>of</strong> <strong>of</strong> the<br />
the<br />
�hole �olore�t�m [��� ���� .�<br />
Of intere��t���� re�ent re�ent re�ent report�� report�� report�� ha�e ha�e ha�e indi�ated indi�ated indi�ated that that �aref�l �aref�l �aref�l �aref�l<br />
m��o��al e�amination aided by �hromoendo���opy and<br />
magnifying endo���opy�� �� and target biop��ie�� biop��ie�� biop��ie�� <strong>of</strong> �����pi�io��� �����pi�io��� �����pi�io���<br />
le��ion�� might pro�ide pro�ide more more effe�ti�e effe�ti�e effe�ti�e ���r�eillan�e ���r�eillan�e ���r�eillan�e ���r�eillan�e than than the<br />
the<br />
the<br />
taking <strong>of</strong> m�ltiple m�ltiple m�ltiple non�targeted non�targeted non�targeted biop��ie�� biop��ie�� biop��ie�� [������ ������ .�<br />
EVALUATION OF ULCERATIVE COLITIS<br />
Histopathologic assessment <strong>of</strong> UC<br />
Se�erity e�erity in �l�erati�e �l�erati�e �l�erati�e �oliti�� �oliti�� �oliti�� �oliti�� i�� i�� i�� i�� generally generally a����e����ed a����e����ed a����e����ed a����e����ed ���ing ���ing ���ing ���ing<br />
��ymptom���� laboratory data [��� ��� ���� ��l�������p�� ���������� [��������� ��������� ����� ���� ��<br />
and the hi��tologi� hi��tologi� hi��tologi� degree <strong>of</strong> inflammation in the biop��y biop��y biop��y<br />
��pe�imen�� [�������9� �������9� ���9� �9� 9� .� Of the��e�� the��e�� hi��topathologi� hi��topathologi� i��topathologi� ologi� logi� a����e����ment a����e����ment a����e����ment a����e����ment a����e����ment<br />
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