ADENOCARCINOMA IN STRICTURES OF ULCERATIVE-COLITIS WITHOUT ANTECEDENTDYSPLASIA BY COLONOSCOPY

We report three patients with chronic ulcerative colitis and colonic s trictures that were found to harbor advanced adenocarcinomas despite p revious endoscopic examinations that had failed to demonstrate dysplas ia or carcinoma. This experience calls into question the reliability o f endoscopic monitoring of the subset of ulcerative colitis patients w ith strictures. Review of the literature supports the thesis that the management of these patients requires a high index of suspicion of mal ignancy, and should include timely consideration of surgery. It is sug gested that evaluation of the effectiveness of endoscopic surveillance programs for patients with ulcerative colitis should consider the sub set of patients with strictures as a separate cohort.