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.
|Indications for surgery in 15 of 49 patients operated on was dysplasia or colorectal cancer
|Scandanavian Journal of Gastroenterology|
This method is not unquestioned and is undergoing continuous evaluation.
Dr Jan Lindberg and colleagues from Sweden updated an earlier reported investigation from an ongoing surveillance programme.
The team reports that a colonoscopic surveillance programme comprising patients with ulcerative colitis from a defined area started in Örnsköldsvik in 1977.
The researchers also reported that 3 principal investigators performed regular colonoscopy with mucosal sampling for histopathological evaluation.
Some 211 patients were studied from 1977 to 2002.
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 patients left after panproctocolectomy, 6 owing to advanced biological age, and 1 because of intercurrent disease.
In addition, the research team reported that 23 patients had moved out of the area and 13 patients were excluded because of poor compliance.
In all, the team noted that 928 colonoscopies were performed.
The researchers found that 135 patients had radiologically or morphologically defined total colitis and 69 patients had left-sided colitis.
The research team observed that 9 colorectal cancers were diagnosed in 8 patients.
One of the patients diagnosed died of colorectal cancer, while another 2 were included in the programme with a diagnosis of colorectal cancer.
The team found morphological alterations classified as dysplasia or indefinite for dysplasia in 52 patients, 5 of whom were later found to have colorectal cancer.
In total, the researchers noted that 49 patients were operated on, and in 15 of these the indication for surgery was dysplasia or colorectal cancer.
The researchers observed that 18 of the patients were operated on 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.”