FAILURE OF COLONOSCOPIC SURVEILLANCE IN ULCERATIVE-COLITIS

A prospective surveillance programme for patients with longstanding (> =8 years), extensive (>=splenic flexure) ulcerative colitis was undert aken between 1978 and 1990. It comprised annual colonoscopy with panco lonic biopsy. One hundred and sixty patients were entered into the pro gramme and had 739 colonoscopies (4-6 colonoscopies per patient; 709 p atient years follow up). Eighty eight per cent of examinations reached the right colon. There was no procedure related death. One Dukes's A cancer was detected. Forty one patients (25%) defaulted. Of these 25 r emain well; 13 are unaccounted for, and one died from colonic cancer. One patient had colectomy for medical reasons, and another died of car cinoma of the pancreas. Retrospectively an additional 16 eligible pati ents were identified who had not been recruited. Of these, 14 remain w ell, two are unaccounted for. None developed colonic cancer. Four pati ents refused colonoscopy. All remain well. Over the same period seven other cases of colonic cancer were found in association with ulcerativ e colitis, two in patients who had erroneously been diagnosed as havin g only proctitis and were therefore not entered into the programme, bu t were found at operation to have total colitis, one in a patient with colitis of seven years duration, and four patients who had previously attended the clinic but had been lost to follow up before 1978 and th en had represented with new symptoms during the surveillance period. T hus, of the nine colitis related cancers diagnosed in this centre duri ng the study period only one was detected by the surveillance programm e. The results of this large study, and a review of published works, c ast doubts on the effectiveness of colonoscopic surveillance programme s in detecting colorectal cancer in patients with ulcerative colitis.