CONSERVATIVE MANAGEMENT OF SMALL ADENOMATA IN ULCERATIVE-COLITIS

Objective and Methods: Patients with chronic ulcerative colitis may de velop colitis-related dysplasia and/or sporadic adenomata, Differentia ting between these two processes is important because they may dictate different therapeutic approaches. Although distinguishing features of sporadic adenomata versus colitis-related dysplasia have been suggest ed previously on an a priori basis, they have never been verified by f ollow-up analysis, We have identified six chronic ulcerative colitis p atients whose discrete adenomata were managed conservatively, with sub sequent continuation in their surveillance programs, Results: Mean pat ient age was 69 yr with a mean 21.3 yr of ulcerative colitis, Surveill ance endoscopy of 63 patient-yr duration yielded 24 adenomata, A mean follow-up after the initial adenoma diagnosis was 7.2 yr with no carci noma identified (including the examination of one prophylactic colecto my specimen), One patient, with a 34-yr history of ulcerative colitis and a single sporadic adenoma subsequently developed dysplasia of flat mucosa 14 months later, Conclusions: Our findings concur with previou s reports and indicate that small, discrete adenomata with morphology identical to those seen in the general population occur in patients wi th ulcerative colitis, Such lesions in patients older than 45 yr, with tubular or tubulovillous architecture and low-grade dysplasia, are ef fectively treated by polypectomy only and are not necessarily an indic ation for colectomy, However, sporadic adenomata and colitis-related d ysplasia can develop metachronously, It is suggested that subsequent t o a diagnosis of sporadic adenoma in a patient with chronic ulcerative colitis, surveillance should increase to colonoscopic examination eve ry 6 to 12 months.