Dr Evelien Dekker and colleagues from the Netherlands evaluated the yield and clinical impact of random biopsies taken during colonoscopic surveillance of patients with longstanding ulcerative colitis.
Retrospective analysis of 1,010 colonoscopies performed from 1998 to 2008.
Colonoscopy and pathology reports were reviewed to assess the yield and clinical impact of random biopsies.
In total, 475 patients with ulcerative colitis who underwent colonoscopy at the Academic Medical Centre Amsterdam were included in this study.
The team's main outcome measures are neoplasia yield per-colonoscopy and clinical impact per-patient of random biopsies.
Of all colonoscopies, 466 were performed for surveillance during which 11,772 random biopsies were taken.
|Neoplasia was detected in random biopsies only in 6% of colonoscopies |
|American Journal Gastroenterology |
Overall, neoplasia was detected in 88 colonoscopies, in 75 colonoscopies by targeted biopsies only and in 8 by both targeted and random biopsies.
The researchers team detected neoplasia in random biopsies only in 6% of colonoscopies in 8% of patients.
The research team noted that 2 of these 4 patients with neoplasia detected only by random biopsies had visible neoplasia in previous colonoscopies.
The team observed that 1 patient had unifocal low-grade intraepithelial neoplasia that could not be confirmed in 3 subsequent colonoscopies.
The researchers found that last patient had multifocal low-grade intraepithelial neoplasia and suspicious appearing ulcerations.
Proctocolectomy confirmed the presence of neoplasia.
Dr Dekker's team concludes, "The yield of random biopsies is low whereas ulcerative colitis-associated neoplasia is macroscopically visible in 94% of colonoscopies."
"During 10-year surveillance, neoplasia was detected in only random biopsies in 4 patients of whom only one had clinical consequences."
"The low yield and lack of clinical consequences from random biopsies in this high-risk population raise questions about the necessity and cost-effectiveness of their routine use during ulcerative colitis surveillance."