Patients with ulcerative colitis have an increased risk of developing colorectal cancer.
The current procedure to diminish this risk is colonoscopic surveillance and histopathological evaluation of biopsy specimens.
This method is not unquestioned and is undergoing continuous evaluation.
The present study is a major update of an earlier reported investigation from an ongoing surveillance programme.
Dr Jan Lindberg and colleagues undertook a colonoscopic surveillance programme comprising all patients with ulcerative colitis in 1977 in Sweden.
Regular colonoscopy with mucosal sampling for histopathological evaluation was performed by 3 principal investigators.
The researchers studied 211 patients from 1977 to 2002.
|135 patients had radiologically or morphologically defined total colitis|
|Scandanavian Journal of Gastroenterology|
At the end of the study period, 90 patients, including those operated on, had total colitis for more than 10 years, and 74 patients had left the study.
The team reported that 31 left after panproctocolectomy, 6 owing to advanced biological age, and 1 because of intercurrent disease.
A further 23 patients had moved out of the area and 13 patients were excluded because of poor compliance.
In all, the research team performed 928 colonoscopies.
The researchers found that 135 patients had radiologically or morphologically defined total colitis and 69 patients had left-sided colitis.
The team diagnosed 9 colorectal cancers in 8 patients, 1 died of colorectal cancer, while another 2 included in the programme had colorectal cancer.
Morphological alterations classified as dysplasia or indefinite for dysplasia were found in 52 patients, 5 of whom were later found to have colorectal cancer.
In total, the team noted that of the 49 patients operated on, 15 of these patients the indication for surgery was dysplasia or colorectal cancer.
The team operated on 18 of the patients for different kinds of colonic resections and in 31 patients a panproctocolectomy was performed.
Dr Lindberg's team concludes, “Colonoscopic surveillance is an effective method in preventing death from colorectal cancer among patients with ulcerative colitis.”
“A conservative approach to surgery seems to be justified.”
“The burden of the surveillance programme has been acceptable.”
“The outcome depends on good patient compliance as well as the involvement of as few investigators as possible.”