Rutter, M.D.; Wilkinson, K.H.; Rumbles, S.; Forbes, A.; Saunders, B.P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA66
Academic Journal
Background & Aim: Patients with longstanding extensive ulcerative colitis (UC) are at increased risk of colorectal cancer (CRC). We assessed the value of a long-running colonoscopic surveillance programme. Methods: Patients on biennial colonoscopic surveillance (from 1975 onwards) with histologically proven UC of at least 8 years duration, macroscopically extending proximal to the splenic flexure were included. All patients were followed up to 1/1/01. Data were obtained from our prospective UC surveillance database, medical records & reports, GPs, other hospitals & the Office of National Statistics. Results: 600 patients underwent 2627 colonoscopies & 5080 years of surveillance. 68 patients (11%) had dysplasia or cancer detected during surveillance. Initial dysplasia was Iow-grade (46), high-grade (10), & CRC (12). 89 patients underwent surgery (86 colectomies, 3 partial resections). Fourteen operations were for a preoperative diagnosis of CRC, 16 for HGD (6 cancers in specimens), 14 for LGD (3 cancers in specimens), & one for an adenoma. 44 operations were for symptoms (5 cancers in specimens). In addition, 2 patients died of CRC without surgery. In total, 30 patients developed CRC within the surveillance programme. Of the 25 surveillancedetected CRCs, 15 (60%) were Dukes' A or B. A further 16 patients had colectomies for dysplasia, & had dysplasia confirmed in the colectomy specimen. Thus 31 patients benefited from surveillance. This equates to one benefit per 19 patients, or one benefit per 164 surveillance years. 13 patients presented with Dukes' C or disseminated malignancy within the surveillance programme. Conclusion: The current colonoscopic surveillance programme benefits approximately 3/4 of patients who are likely to develop lifethreatening cancers. However, it requires considerable effort and expense over a prolonged period of time. A significant minority of patients still present with advanced cancer despite surveillance...


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