The risk of colorectal cancer is increased in ulcerative colitis (UC).
Patients with UC have diverse colonoscopic appearances.
Determining colonoscopic markers for cancer risk could allow patient risk stratification.
A previous study demonstrated a correlation between inflammation severity and neoplasia risk.
Following on from this, Dr Rutter and colleagues from England undertook a case control study in order to look for colonoscopic markers of colorectal neoplasia risk in UC.
The researchers matched each patient who had neoplasia detected between 1988 and 2002 with two non-dysplastic colitic controls.
The research team then collected data on post-inflammatory polyps, scarring, strictures, backwash ileitis, a shortened, tubular, or featureless colon, severe inflammation, and normal looking surveillance colonoscopies.
|5 year risk of colorectal cancer following normal colonoscopy was no different from matched controls|
There were 68 cases in total and the research group matched them all with suitable controls (n = 136).
The researchers performed univariate analysis, and found that cases were significantly more likely to have post-inflammatory polyps, strictures, shortened colons, tubular colons, or segments of severe inflammation, and less likely to have had a macroscopically normal looking colonoscopy.
In addition, the research team found that after multivariate analysis, a macroscopically normal looking colonoscopy, post-inflammatory polyps, and strictures remained significant.
The team found that the 5 year risk of colorectal cancer following a normal looking colonoscopy was in fact no different from that of matched general population controls.
Macroscopic colonoscopic features help predict neoplasia risk in UC.
Features of previous/ongoing inflammation signify an increased risk.
Dr Rutter concluded, "A macroscopically normal looking colonoscopy returns the cancer risk to that of the general population: it should be possible to reduce surveillance frequency to 5 years in this cohort."