Observer study of the grading of dysplasia in ulcerative colitis: Comparison with clinical outcome

Melville, David M.; Jass, J R; Morson, B. C.; Pollock, D. J.; Richman, P. I.; Shepherd, Neil A.; Ritchie, Jean K.; Love, Sharon; Lennard‐Jones, J. E.

doi:10.1016/0046-8177(89)90273-6

Cited by 200 publications

(99 citation statements)

References 14 publications

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“…There is still no consensus on management in cases of unifocal or multifocal low grade dysplasia (LGD) in flat mucosa. What complicates the issue, as earlier studies have indicated, is that there seems to be difficulty in confirming dysplasia by the pathologist [7,8] . The management of the different forms of dysplasia varies from no management or intensifying the screening program to immediate colectomy.…”

Section: Introductionmentioning

confidence: 75%

Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn’s colitis patients in the Netherlands

Rijn

Fockens²,

Siersema³

et al. 2009

WJG

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AIM:To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS:A questionnaire was sent to all 244 gastroenterologists in the Netherlands. RESULTS:The response rate was 63%. Of all gastroenterologists, 95% performed endoscopic surveillance in ulcerative colitis (UC) patients and 65% in patients with Crohn's colitis. The American Gastroenterological Association (AGA) guidelines were followed by 27%, while 27% and 46% followed their local hospital protocol or no specific protocol, respectively. The surveillance was correctly initiated in cases of pancolitis by 53%, and in cases of left-sided colitis by 44% of the gastroenterologists. Although guidelines recommend 4 biopsies every 10 cm, less than 30 biopsies per colonoscopy were taken by 73% of the responders. Only 31%, 68% and 58% of the gastroenterologists referred patients for colectomy when low-grade dysplasia, high-grade dysplasia (HGD) or Dysplasia Associated Lesion or Mass (DALM) was present, respectively. CONCLUSION:

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Section: Introductionmentioning

confidence: 75%

Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn’s colitis patients in the Netherlands

Rijn

Fockens²,

Siersema³

et al. 2009

WJG

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“…Th e standardization of " high-grade " and " low-grade " dysplasia published by the Infl ammatory Bowel Disease -Dysplasia Morphology Group (IBD-DMG) has been widely adopted and has served to make the diagnosis of dysplasia more stringent and more consistent ( 412 ). When colon cancer is identifi ed, the need for surgery is obvious; similarly, the colonoscopic biopsy diagnosis of dysplasia in fl at mucosa is oft en indicative of a concurrent or future cancer.…”

Section: Recommendations For Cancer Surveillancementioning

confidence: 99%

“…However, attempts to repeatedly show dysplasia on subsequent examinations before recommending colectomy should not be undertaken without the awareness of the high risk of concomitant or subsequent advanced neoplasia by both patient and physician. Conversely, the patient whose biopsies are interpreted as " indefi nite " for dysplasia should have the slides reviewed by an expert gastrointestinal pathologist and should undergo repeat surveillance colonoscopy at a briefer interval ( 412 ), because these patients may have an elevated risk of subsequent progression to defi nite dysplasia ( 389 ).…”

Section: Recommendations For Cancer Surveillancementioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,154

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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“…All specimens were examined for the presence of dysplasia or carcinoma according to standardized criteria 5 and classified as no dysplasia, reactive atypia, low-grade dysplasia, high-grade dysplasia or carcinoma. Reactive atypia described histological changes caused by an inflammatory reaction or by regenerative activity that was not frankly dysplastic.…”

Section: Methodsmentioning

confidence: 99%

Risk of dysplasia in the columnar cuff after stapled restorative proctocolectomy

Coull

Lee

Henderson

et al. 2003

British Journal of Surgery

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Background: Stapled restorative proctocolectomy (SRP) for ulcerative colitis retains a 'cuff ' of columnar epithelium, which carries a risk of undergoing malignant change. The risk of neoplastic transformation was studied in a series of patients who underwent SRP for ulcerative colitis. Methods:One hundred and thirty-five patients who underwent SRP for ulcerative colitis between 1988 and 1998 were followed up by cuff surveillance biopsy. The median follow-up was 56 (range 12-145) months and the median time since diagnosis of ulcerative colitis was 8·8 (range 2-32) years. Results:The cuff biopsies showed no dysplasia or carcinoma. The accuracy of obtaining cuff mucosa in the biopsy was 65 per cent. Chronic inflammation was present in 94 per cent of cuff biopsies. Conclusion:This study shows no evidence of either dysplasia or carcinoma in the columnar cuff mucosa, up to 12 years after pouch formation. This suggests that cuff surveillance in the first decade after SRP, in the absence of dysplasia or carcinoma in the original colectomy specimen, may be unnecessary. Regular cuff surveillance biopsies after SRP should continue for patients with high-grade dysplasia or carcinoma in the original resection specimen.

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Observer study of the grading of dysplasia in ulcerative colitis: Comparison with clinical outcome

Cited by 200 publications

References 14 publications

Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn’s colitis patients in the Netherlands

Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn’s colitis patients in the Netherlands

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Risk of dysplasia in the columnar cuff after stapled restorative proctocolectomy

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