Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis.
OBJECTIVE
The value of colonoscopic surveillance for neoplasia in long-standing extensive ulcerative colitis remains controversial. This study reports on prospectively collected data from a surveillance program over a 30-year period.


METHODS
Data were obtained from the prospective surveillance database, medical records, colonoscopy, and histology reports. The primary end point was defined as death, colectomy, withdrawal from surveillance, or census date (January 1, 2001). Follow-up information was obtained for patients who left the program.


RESULTS
Six hundred patients underwent 2627 colonoscopies during 5932 patient-years of follow-up. The cecal intubation rate was 98.7%, with no significant complications. Seventy-four patients (12.3%) developed neoplasia, including 30 colorectal cancers (CRCs). There was no difference in median age at onset of colitis for those with or without CRC (P = .8, Mann-Whitney). The cumulative incidence of CRC by colitis duration was 2.5% at 20 years, 7.6% at 30 years, and 10.8% at 40 years. The 5-year survival rate was 73.3%. Sixteen of 30 cancers were interval cancers. CRC incidence decreased over time (r = -.40, P = .04; linear regression).


CONCLUSIONS
Colonoscopic surveillance is safe and allows the vast majority of patients to retain their colon. Although two thirds of patients with potentially life-threatening neoplasia benefited from surveillance, the program was not wholly effective in cancer prevention. The cancer incidence, however, was considerably lower than in the majority of other studies, and was constant for up to 40 years of colitis duration, suggesting there is no need to intensify surveillance over time.
Rutter
Matthew D
MD
Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Teesside, England. matt.rutter@nth.nhs.uk
Saunders
Brian P
BP
Wilkinson
Kay H
KH
Rumbles
Steve
S
Schofield
Gillian
G
Kamm
Michael A
MA
Williams
Christopher B
CB
Price
Ashley B
AB
Talbot
Ian C
IC
Forbes
Alastair
A
D000236:Adenoma / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000473:pathology*; D003108:Colonic Diseases / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011159:Population Surveillance; D016019:Survival Analysis