Clinical–alimentary tractThirty-Year Analysis of a Colonoscopic Surveillance Program for Neoplasia in Ulcerative Colitis
Section snippets
Surveillance Program
St Mark’s Hospital established a surveillance program for patients with long-standing extensive UC in 1971.5 By the mid-1970s, colonoscopy had become the main surveillance modality. Patients with histologically proven UC and macroscopic inflammation proximal to the splenic flexure (judged initially by barium enema but since the mid-1970s by colonoscopy) have been offered 1 to 2 yearly surveillance colonoscopies from 8 years after symptom onset. Segmental nontargeted mucosal biopsy specimens
Study Population
The surveillance population comprised 600 patients (343 male, 257 female). The median age at onset of colitic symptoms was 28 years (range, 1–64 years). Cumulative patient-year follow-up evaluation to primary end point was 5080 years (mean, 8.5 years). The total study follow-up evaluation was 5932 patient-years. As of January 1, 2001, there were 354 patients who remained on surveillance (Table 1). Secondary end points are detailed in Table 2.
Colonoscopy Data
During the study, 2627 colonoscopies were performed
Discussion
This study represents a single-center review of a surveillance program on UC that has been in existence for more than 30 years.
Conclusions
In summary, colonoscopic surveillance allowed the vast majority of asymptomatic patients with extensive UC to retain their colon throughout over 5000 patient-years of surveillance. Better than 94% long-term compliance and colonoscopic completion rates of 98.7% were achieved with no complications.
An important observation from this study is that within this surveillance program, cancer incidence was constant over colitis duration for up to 40 years, suggesting there is no need to intensify
References (42)
Endoscopic surveillance in ulcerative colitis still does not work (letter)
Gastroenterology
(1995)- et al.
Cancer surveillance in ulcerative colitis. Experience over 15 years
Lancet
(1983) - et al.
Colonoscopic polypectomy in chronic colitisconservative management after endoscopic resection of dysplastic polyps
Gastroenterology
(1999) - et al.
Polypectomy may be adequate treatment for adenoma-like dysplastic lesions in chronic ulcerative colitis
Gastroenterology
(1999) - et al.
Dysplasia in inflammatory bowel diseasestandardized classification with provisional clinical applications
Hum Pathol
(1983) - et al.
Factors affecting the outcome of endoscopic surveillance for cancer in ulcerative colitis
Gastroenterology
(1994) - et al.
Colorectal cancer risk and mortality in patients with ulcerative colitis
Gastroenterology
(1992) - et al.
Cancer in universal and left-sided ulcerative colitisfactors determining risk
Gastroenterology
(1979) - et al.
Colorectal cancer in patients with ulcerative colitis
Gastroenterology
(1988) - et al.
Most dysplasia in ulcerative colitis is visible at colonoscopy
Gastrointest Endosc
(2004)