Thirty-Year Analysis of a Colonoscopic Surveillance Program for Neoplasia in Ulcerative Colitis

Rutter, Matthew D.; Saunders, Brian P.; Wilkinson, Kay H.; Rumbles, Steve; Schofield, Gillian; Kamm, Michael A.; Williams, Christopher; Price, Ashley B.; Talbot, Ian C.; Forbes, Alastair

doi:10.1053/j.gastro.2005.12.035

Cited by 601 publications

(444 citation statements)

References 40 publications

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“…Although these studies suggest that the relative risk of CRC is considerably lower than previously described, some would argue that the low rates of CRC observed in these studies are the successful result of timely and appropriate access to good health care, including maintenance therapies, surveillance colonoscopy, and surgery [20] . This is further corroborated by the data arising from a large colonoscopic surveillance program at St. Mark's Hospital between 1970 and 2001 [17] . Six hundred patients with extensive UC were followed up for 5932 person-years.…”

supporting

confidence: 62%

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Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

Lakatos¹,

Lakatos²

2008

WJG

373

245

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Since the first report of an inflammatory bowel disease (IBD) case associated with colorectal cancer (CRC) by Crohn and Rosenberg [1] , significant efforts have been made to elucidate this presumed association. Nowadays, the association between IBD and the increased risk for CRC is widely accepted. Although CRC, complicating ulcerative colitis and Crohn's disease, accounts only for 1%-2% of all cases of CRC in the general population, it is considered a serious complication of the disease and accounts for approximately 10%-15% of all deaths in IBD patients [2] . The age at diagnosis of CRC associated with IBD is 15-20 years earlier compared to sporadic cancers. In the meta-analysis by Eaden et al [3] , the average age at diagnosis was 43.2 years. Similarly, in a recent publication from Eastern Europe [4] , it was found to be 50.9 years, 10-15 years younger compared to sporadic CRC cases from the same area (62.2 years) [5] . According to US [6] and Canadian [7] publications, almost two-thirds of the affected patients were males, yet results are conflicting [4,8] . In addition, the frequency of multiple CRCs is higher than in patients with sporadic CRC [9] .The increased risk of CRC in UC is almost a universal finding [3,[10][11][12][13] , yet the extent of this risk varies considerably with differences in study design and geographic area. The initial reports were published by tertiary gastroenterology centers, thus the high risk detected might have been a consequence of referral bias and overinterpretation due to the high percentage of extensive and chronically active cases in these cohorts. Results of population-based studies are more reliable; however, several geographical and ethnic differences have been noted.The report of the meta-analysis by Eaden et al [3] in 2001 was one of several milestones in this subject. The incidence of UC-associated CRC was estimated based on 116 articles involving 54 478 patients in whom 1698 CRC cases were detected. This was a mixture of referral center-based, hospital-based, and population-based studies of variable methodological qualities and levels of detail. The reported incidence was higher in the US AbstractThe risk of colorectal cancer for any patient with ulcerative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer include extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflammation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epidemiological trends and causes for the observed changes. Population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this chang...

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supporting

confidence: 62%

“…An additional option may be that the population-based acquisition of the data, in other words, the study design per se, is at least partially responsible for the apparent decline in the incidence rates. In these studies, the proportion of severe or extensive cases was much lower compared to that reported by tertiary centers [3,17] .…”

mentioning

confidence: 83%

Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

Lakatos¹,

Lakatos²

2008

WJG

373

245

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“…Beide Syndrome wurden mit einem -zum Teil deutlich -erhöhten KRKRisiko in Verbindung gebracht [392 -396] [399]. Dies basiert darauf, dass Colitis-assoziierte Kolonkarzinome früher erkannt werden, obwohl dennoch zwischen Überwachungsunter-suchungen Intervallkarzinome auftreten können [400]. Das Karzinomrisiko steigt mit der Krankheitsdauer und der Krankheitsausdehnung an, weshalb bei Patienten mit einer Pancolitis die regelmäßige Überwachung früher als bei Patienten mit einer distalen Colitis beginnen sollte.…”

Section: Level Of Evidence 1cunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

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“…[16,17] The predictive value of dysplasia has therefore led to consensus and expert-opinion guidelines that advise proctocolectomy when high grade dysplasia is identified and suggest that it be carefully considered when low grade dysplasia is identified. Despite these recommendations, there remains no prospective study demonstrating a mortality benefit from proctocolectomy, [18] and it is believed that due to ethical and logistical challenges, such a study will not be performed.…”

Section: How Should Dysplasia Be Managed?mentioning

confidence: 99%

Surveillance of Dysplasia in Inflammatory Bowel Disease: The Gastroenterologist-Pathologist Partnership

Rubin

Turner

2006

Clinical Gastroenterology and Hepatology

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Cancer prevention in inflammatory bowel disease depends on the detection of precancerous dysplasia during scheduled screening and surveillance colonoscopy, but the detection and diagnosis of dysplasia remains challenging. In this article, we review the risks of cancer and dysplasia in ulcerative colitis, the current prevention recommendations and, through a sample case, demonstrate an approach that involves an active partnership between the gastroenterologist or surgeon and pathologist. We address the challenge of management of polypoid lesions and incorporate new information about degree of inflammation as an additional risk of neoplasia in these patients. Keywords ulcerative colitis; surveillance; dysplasia; colorectal cancer Case PresentationA 45 year-old man with left-sided ulcerative colitis diagnosed at age 21 is seen in your office as a new patient and inquires about colorectal cancer prevention. He has undergone periodic surveillance colonoscopy since he was in his early 30s and his last examination was performed 2 years ago and revealed no dysplasia. After discussing current guidelines, you recommend an endoscopic examination with surveillance biopsies. Colonoscopy reveals vascular blunting and minimal touch friability diffusely from the rectum to the hepatic flexure, and an endoscopically normal ascending colon and cecum. This also a 2 cm polypoid lesion with exudate on its surface (Figure 1), but no masses or strictures. You obtain numerous surveillance biopsies throughout the colon and perform snare polypectomy of the polyp, with additional biopsies of the flat mucosa surrounding it. You submit these to the Pathology Department along with a report of the patient's history and these endoscopic findings. Your pathologist calls to report that all of the biopsies show mild active inflammation and architectural distortion, typical of mildlyactive chronic ulcerative colitis, and the polyp appears inflammatory in nature (Figure 2). However, there are also two separate biopsies from non-polypoid areas that include low grade dysplasia. A second gastrointestinal pathologist was consulted and concurs with the diagnosis of mulitfocal low grade dysplasia. You inform the patient and recommend proctocolectomy and ileo-pouch anal anastomosis, to which he agrees. The colectomy specimen reveals several Address correspondence to: David T. Rubin, MD 5841 S. Maryland Ave. MC 4076 Chicago, IL 60637 drubin@uchicago.edu 773-702-2950. Dr. Rubin and Dr. Turner have no conflicts of interest related to this publication Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errorsmaybe discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Acce...

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Thirty-Year Analysis of a Colonoscopic Surveillance Program for Neoplasia in Ulcerative Colitis

Cited by 601 publications

References 40 publications

Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

S3-Leitlinie – Kolorektales Karzinom

Surveillance of Dysplasia in Inflammatory Bowel Disease: The Gastroenterologist-Pathologist Partnership

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