Prophylactic colectomy or surveillance for chronic ulcerative colitis? A decision analysis.
OBJECTIVE
The treatment of patients with long-standing ulcerative colitis involving the entire colon is controversial. The aim of this study was to examine the effectiveness of surveillance colonoscopy or prophylactic colectomy on colon cancer mortality in patients with chronic ulcerative colitis.


METHODS
Using decision analysis, computer cohort simulation of patients with ulcerative colitis was performed to evaluate 17 strategies including no colonoscopic surveillance, surveillance at varying intervals, and prophylactic proctocolectomy with ileal pouch-anal anastomosis. The model examined which biopsy results (low-grade dysplasia, high-grade dysplasia, or cancer) should lead to proctocolectomy and ileal pouch-anal anastomosis. Published data on the incidence of cancer with ulcerative colitis, the sensitivity and specificity of colonoscopy with biopsy, the risks of colonoscopy and surgery, and the prognosis with colon cancer were used.


RESULTS
For a 30-year-old patient with pancolitis for 10 years, the model suggests that prophylactic colectomy would increase life expectancy by 2-10 months compared with surveillance and by 1.1-1.4 years compared with no surveillance. Surveillance would improve life expectancy by 7 months to 1.2 years compared with no surveillance. In sensitivity analysis, results were most affected by the cumulative incidence of cancer in patients with chronic ulcerative colitis.


CONCLUSIONS
Either surveillance or prophylactic colectomy should increase life expectancy in patients with ulcerative colitis.
Provenzale
D
D
Tufts University School of Medicine, Division of Gastroenterology, Boston, Massachusetts, USA.
Kowdley
K V
KV
Arora
S
S
Wong
J B
JB
D000328:Adult; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000401:mortality; D003110:Colonic Neoplasms / Q000517:prevention & control*; D003113:Colonoscopy; D003198:Computer Simulation; D003661:Decision Support Techniques; D006801:Humans; D008017:Life Expectancy; D016737:Proctocolectomy, Restorative; D011379:Prognosis