The value of colonoscopic surveillance for neoplasia in long-standing extensive ulcerative colitis remains controversial.
Dr Matthew Rutter and research team from England prospectively collected data from a surveillance program over a 30-year period.
The research team obtained data from the prospective surveillance database, medical records, colonoscopy, and histology reports.
The primary end point was defined as death, colectomy, withdrawal from surveillance, or census date.
Follow-up information was obtained for patients who left the program.
The researchers reported that 600 patients underwent 2627 colonoscopies during 5932 patient-years of follow-up.
|Colorectal cancer incidence by colitis duration was 3% at 20 years, and 8% at 30 years|
The cecal intubation rate was 99%, with no significant complications.
The team found that 12% developed neoplasia, including colorectal cancers.
The research team observed no difference in median age at onset of colitis for those with or without colorectal cancer.
The cumulative incidence of colorectal cancer by colitis duration was 3% at 20 years, 8% at 30 years, and 11% at 40 years.
The team noted that the 5-year survival rate was 73%.
In addition, the researchers observed that 16 of 30 cancers were interval cancers.
Colorectal cancer incidence decreased over time.
Dr Rutter's team concluded, “Colonoscopic surveillance is safe and allows the vast majority of patients to retain their colon.”
“Although most patients with potentially life-threatening neoplasia benefited from surveillance, the program was not wholly effective in cancer prevention.”
“The cancer incidence, however, was considerably lower than in the majority of other studies, and was constant for up to 40 years of colitis duration, suggesting there is no need to intensify surveillance over time.”