BACKGROUND & AIMS:Unlike ulcerative colitis, there are few reports on the efficacy of surveillance colonoscopy in patients with chronic Crohn's colitis and therefore little agreement as to whether routine surveillance is indicated. We report on 259 patients with chronic Crohn's colitis who underwent screening and subsequent surveillance colonoscopy and biopsy since 1980. METHODS: Biopsies were performed at 10-cm intervals and from strictures and polypoid masses. Pathology was classified as normal, dysplasia (indefinite, low-grade, high-grade), or carcinoma. RESULTS: A total of 663 examinations were performed on 259 patients. The median interval between examinations was 24 months; examinations were performed more frequently (1-6 months) in patients with dysplasia on biopsy. A thinner-caliber colonoscope was required to complete 12% of screening examinations and 23% of surveillance examinations. The pediatric colonoscope helped increase our yield of neoplasia by 19%. The screening and surveillance program detected dysplasia or cancer in 16% (10 indefinite, 23 low-grade, and 4 high-grade dysplasias and 5 cancers). A finding of definite dysplasia or cancer was associated with age >45 years and increased symptoms. By life table analysis, the probability of detecting dysplasia or cancer after a negative screening colonoscopy was 22% by the fourth surveillance examination. CONCLUSIONS:Colonoscopic surveillance should be strongly considered in chronic extensive Crohn's colitis.

背 景 与 目 的：慢性克隆病不象溃疡性结肠炎，很少有报道用结肠镜监测慢性克隆病结肠炎患者，因此很少有人赞成常规进行监测。我们自1980年以来，报道了259例接受结肠镜和肠活检筛选和监测的慢性克隆病结肠炎患者。方 法：每间隔10cm从罹患和息肉处进行肠活检。病理分型为正常、发育不良（不确定、低度和高度）或癌症。结 果：共对259名患者进行了663项检查。检查时间平均间隔24个月。对于活检为发育不良的患者检查次数增加（1-6个月）。用细径结肠镜进行12%的筛选检查和23%的监测检查。小儿结肠镜检查使发现肿瘤的几率增加19%。筛选和监测过程发现16%的患者有发育不良或癌症（10个不确定，23个低度，4个高度发育不良，5个癌症）。不确定发育不良和癌症常伴年龄大于45岁，症状加重。寿命表分析表明，筛选检查阴性，进行第四次监测检查后发现发育不良或癌症的可能性为22%。结 论：应高度考虑对慢性广泛克隆病结肠炎患者进行结肠镜监测