Rutter, M.D.; Wilkinson, K.H.; Saunders, B.P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA4
Academic Journal
Background and Aim: During colonoscopic surveillance for dysplasia in longstanding extensive ulcerative colitis (UC), multiple non-targeted "random" biopsies of colonic mucosa are advised, based on historical data suggesting dysplasia may only be detectable microscopically. We aimed to assess what proportion of dysplastic lesions were macroscopically evident at colonoscopy. Methods: All cases of colonoscopically detected dysplasia in a major UC surveillance programme from 1/1/88 to 1/1/02 were reviewed. Details were obtained from our colonoscopy database, case notes (including colonoscopic photographs), and histology reports. All dysplasia was assumed to be macroscopically invisible unless stated otherwise at the time. Results: During the study period, 300 patients underwent 2189 colonoscopies. Fifty six patients had one or more biopsies showing colorectal dysplasia. In total, 92 colonoscopies yielded 106 positive biopsies. Eighty one (76%) dysplastic biopsies were from macroscopically visible lesions, and 25 sites of dysplasia (24%) were macroscopically invisible. Thirty three lesions were considered endoscopically and histologically to be tubular adenomas. Excluding these, there were 73 dysplastic biopsies (38 patients, 65 colonoscoples). 48 (66%) of these were from macroscopically visible lesions. Overall, 50 patients (82%) had macroscopically detectable dysplasia during the study period, and six patients with dysplasia (18%) had only macroscopically invisible lesions. Conclusion: Over 80% of patients with dysplastic lesions in ulcerative colitis will develop a colonoscopically visible lesion. Even after excluding tubular adenomatous lesions, the majority of dysplasia is colonoscopically visible. Colonoscopists should concentrate on careful mucosal scrutiny for dysplastic lesions, rather than relying solely on detection by random.


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