CANCER SURVEILLANCE COLONOSCOPY IN ULCERATIVE-COLITIS - SENSE OR NONSENSE

Surveillance in patients at risk for the development of cancer in the setting of ulcerative colitis is a common part of the management of th ese patients. There is controversy as to the efficacy of surveillance, the key issues relating to cost and reduction of cancer risk. Colonos copic surveillance makes sense when it can be shown to detect cancers at a curable stage or be used to prevent cancer. The use of ''low grad e dysplasia'' as an indication for early colectomy may have a favorabl e impact on survival statistics. The costs for surveillance compared f avorably to the costs for flexible sigmoidoscopy surveillance for cole -rectal cancer. The negative answer to the question relates to studies suggesting that the cancer risk is overestimated and that ''low-grade '' dysplasia is of little prognostic value. Advocates of this policy r ecommend a non-surveillance or ''follow-up'' program. Two approaches t hat may improve efficacy are to target the high risk population for an increased frequency of surveillance and to enhance the accuracy of th e dysplasia marker. Studies with flow cytometry are encouraging with D NA aneuploidy in colonic biopsies shown to have predictive value for t he development of dysplasia in ulcerative colitis. Overall, surveillan ce seems warranted due to the risk, fear of cancer among patients, and the excess mortality among the entire inflammatory bowel disease popu lation. The availability of the newer molecular tools could provide im provement in the surveillance approach.