ARE WE TELLING PATIENTS THE TRUTH ABOUT SURVEILLANCE COLONOSCOPY IN ULCERATIVE-COLITIS

The recommended approach to the increased risk of colorectal carcinoma in Ulcerative colitis has been colonoscopic surveillance rather than prophylactic colectomy. This strategy is based on the assumption that dysplastic lesions can be detected before invasive cancer has develope d. We have analysed published reports on dysplasia surveillance to fin d out whether this assumption is valid. Ten prospective studies (1225 patients) satisfied our criteria. Of 40 patients with dysplasia-associ ated mass or lesion (DALM) detected, 17 (43%) already had cancer at im mediate colectomy. The risks of cancer at immediate colectomy were 42% (10 of 24 patients) for high-grade and 19% (3 of 16) for low-grade dy splasia. Of 47 patients found to have high-grade dysplasia after the i nitial colonoscopy, 15 (32%) had cancer. 16-29% of patients with untre ated low-grade dysplasia progressed to DALM, high-grade dysplasia, or cancer. Of patients with indefinite results, 28% progressed to high-gr ade dysplasia and 9% to cancer, so continued surveillance is essential . The risk of progression to dysplasia was only 2.4% for patients whos e initial result was negative, so surveillance could perhaps be less f requent for these patients. Immediate colectomy is essential for all p atients diagnosed with high-grade or low-grade dysplasia. A diagnosis of dysplasia does not preclude the presence of invasive cancer. We bel ieve that patients should be informed about the limitations of colonos copic surveillance so that they can take part rationally in decision-m aking about their management.