FACTORS AFFECTING THE OUTCOME OF ENDOSCOPIC SURVEILLANCE FOR CANCER IN ULCERATIVE-COLITIS

Background/Aims: Cancer surveillance in patients with ulcerative colit is is of unproven benefit. This study assesses the efficacy and analyz es factors limiting the success of a surveillance program during a 21- year period in 332 patients with ulcerative colitis to the hepatic fle xure and disease duration exceeding 10 years. Methods: Clinical assess ment and sigmoidoscopy with biopsy was undertaken yearly. Colonoscopy and biopsy every 10 cm throughout the colon was performed every 2 year s or more often if dysplasia was found. Only biopsy specimens reported as showing dysplasia were reviewed. Results: Surveillance contributed to detection of 11 symptomless carcinomas (8 Dukes A, 1 Dukes B, and 2 Dukes C), but 6 symptomatic tumors (4 Dukes C and 2 disseminated) pr esented 10-43 months after a negative colonoscopy. Dysplasia without c arcinoma was confirmed in 12 symptomless patients who underwent colect omy. The 5-year predictive value of low-grade dysplasia for either can cer or high-grade dysplasia was 54% using current criteria. Conclusion s: Surveillance identified some patients at a curable stage of cancer or with dysplasia. Limiting factors were failure to include patients w ith presumed distal colitis, biennial colonoscopy, the number of biops y specimens at each colonoscopy, and variation in histological identif ication and grading of dysplasia.