Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis?

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Gastrointestinal Endoscopy Volume 65, Issue 7, June 2007, Pages 998-1004

doi:10.1016/j.gie.2006.09.025 Copyright © 2007 American Society for Gastrointestinal Endoscopy Published by Mosby, Inc.

Original Article

Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis?

T. Rubin MD, a, Jami A. Rothe BSa, T. Hetzel ABa, D. Cohen MDa and B. Hanauer MDa aCurrent affiliations: The Reva and Logan Gastrointestinal Clinical Research Center at the University of Chicago, Chicago, Illinois, USA Chicago, Illinois, USA. Available online 23 April 2007.

Visible dysplasia: what you see is most of what you getGastrointestinal Endoscopy, Volume 65, Issue 7, June 2007, Pages 1005-1006

Background

Dysplasia and colorectal cancer (CRC) in ulcerative colitis (UC) develop via pathways distinct from sporadic CRC and may occur in flat mucosa indistinct from surrounding tissue. Surveillance guidelines, therefore, have emphasized the `roach of periodic endoscopic examinations and systematic random biopsies of involved mucosa. Given the imperfect nature of this random approach, recent work has focused on improved surveillance techniques and suggests that neoplasia is endoscopically visible in many patients. Objective To assess the endoscopic visibility of dysplasia and CRC in UC. Design This was a retrospective review that used the University of Chicago Inflammatory Bowel Disease Registry and the clinical administrative database. All cases of dysplasia or CRC in UC between November 1994 and October 2004 were identified. The approach to surveillance in these patients included both random biopsies at approximately 10-cm intervals throughout the involved colon and directed biopsies of polypoid lesions, masses, strictures, or irregular mucosa distinct from surrounding inflamed tissue. Findings on endoscopy were compared with pathologic findings from biopsy or surgical specimens. Visible dysplasia was defined as a lesion reported by the endoscopist that led to directed biopsy and that was confirmed by pathology. Invisible dysplasia was defined as dysplasia diagnosed on pathology but not described on endoscopy. Per-lesion and per-patient sensitivities were determined. Setting Tertiary referral center. Patients Database of patients with inflammatory bowel disease seen at the University of Chicago. Main Outcome Measurements Endoscopically visible neoplasia. Results In this database, there were 1339 surveillance examinations in 622 patients with UC. Forty-six patients were found to have dysplasia or CRC at a median age of 48 years and with median duration of disease of 20 years. Of these patients, 77% had pancolitis, 21% had left-sided colitis, and 2% had proctitis. These patients had 128 surveillance examinations (median 3 per patient; range, 1-9 per patient), and, in 51 examinations, 75 separate dysplastic or cancerous lesions were identified (mean, 1.6 lesions per patient; standard deviation, 1.3). Thirty-eight of 65 dysplastic lesions (58.5%) and 8 of 10 cancers (80.0%) were visible to the endoscopist as 23 polyps and masses, 1 stricture, and 22 irregular mucosa. The per-patient sensitivities for dysplasia and for cancer were 71.8% and 100%, respectively. The overall per-lesion and per-patient sensitivities were 61.3% and 76.1%, respectively. Limitations Retrospective review of clinical databases and medical records. Conclusions Dysplasia and cancer in UC are endoscopically visible in most patients and may be reliably identified during scheduled examinations. Future surveillance guidelines should incorporate this information. Reprint requests: T. Rubin, MD, Department of Medicine, University of Chicago, 5841 S. land Ave, MC 4076, Chicago, IL 60637.