INFLAMMATORY BOWEL DISEASE

Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk

M D Rutter¹, B P Saunders², K H Wilkinson², S Rumbles², G Schofield², M A Kamm², C B Williams², A B Price², I C Talbot², A Forbes²

¹ Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Teesside, UK
² St Mark’s Hospital, Harrow, London, UK

Correspondence to:
Correspondence to:
Dr M Rutter
University Hospital of North Tees, Stockton-on-Tees, Teesside TS19 8PE, UK; Matt.rutter{at}nth.nhs.uk

Background and aims: The risk of colorectal cancer is increased in ulcerative colitis (UC). Patients with UC have diverse colonoscopic appearances. Determining colonoscopic markers for cancer risk could allow patient risk stratification.

Patients and methods: Following on from an earlier study which demonstrated a correlation between inflammation severity and neoplasia risk, a case control study was performed to look for colonoscopic markers of colorectal neoplasia risk in UC. Each patient with neoplasia detected between 1988 and 2002 was matched with two non-dysplastic colitic controls. Data were collected on post-inflammatory polyps, scarring, strictures, backwash ileitis, a shortened, tubular, or featureless colon, severe inflammation, and normal looking surveillance colonoscopies.

Results: Cases (n = 68) and controls (n = 136) were well matched. On univariate analysis, cases were significantly more likely to have post-inflammatory polyps (odds ratio (OR) 2.14 (95% confidence interval 1.24–3.70)), strictures (OR 4.22; 1.08–15.54), shortened colons (OR 10.0; 1.17–85.6), tubular colons (OR 2.03; 1.00–4.08), or segments of severe inflammation (OR 3.38; 1.41–10.13), and less likely to have had a macroscopically normal looking colonoscopy (OR 0.40; 0.21–0.74). After multivariate analysis, a macroscopically normal looking colonoscopy (OR 0.38; 0.19–0.73), post-inflammatory polyps (2.29; 1.28–4.11), and strictures (4.62; 1.03–20.8) remained significant. The five year risk of colorectal cancer following a normal looking colonoscopy was no different from that of matched general population controls.

Conclusions: Macroscopic colonoscopic features help predict neoplasia risk in UC. Features of previous/ongoing inflammation signify an increased risk. A macroscopically normal looking colonoscopy returns the cancer risk to that of the general population: it should be possible to reduce surveillance frequency to five years in this cohort.

Abbreviations: UC, ulcerative colitis; OR, odds ratio

Keywords: colonoscopy; colorectal cancer screening; surveillance; ulcerative colitis; dysplasia

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Digest

Robin Spiller
Gut 2004 53: 1723. [Extract] [Full Text] [PDF]

Increased gut permeability in Crohn’s disease: is TNF the link?

P R Gibson
Gut 2004 53: 1724-1725. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Lutgens, M W M D, Vleggaar, F P, Schipper, M E I, Stokkers, P C F, van der Woude, C J, Hommes, D W, de Jong, D J, Dijkstra, G, van Bodegraven, A A, Oldenburg, B, Samsom, M (2008). High frequency of early colorectal cancer in inflammatory bowel disease. Gut 57: 1246-1251 [Abstract] [Full Text]  
• Kamm, M A, Lichtenstein, G R, Sandborn, W J, Schreiber, S, Lees, K, Barrett, K, Joseph, R (2008). Randomised trial of once- or twice-daily MMX mesalazine for maintenance of remission in ulcerative colitis. Gut 57: 893-902 [Abstract] [Full Text]  
• Kitiyakara, T, Chapman, R W (2008). Chemoprevention and screening in primary sclerosing cholangitis. Postgrad. Med. J. 84: 228-237 [Abstract] [Full Text]  
• Lewis, K., Caldwell, J., Phan, V., Prescott, D., Nazli, A., Wang, A., Soderholm, J. D., Perdue, M. H., Sherman, P. M., McKay, D. M. (2008). Decreased epithelial barrier function evoked by exposure to metabolic stress and nonpathogenic E. coli is enhanced by TNF-{alpha}. Am. J. Physiol. Gastrointest. Liver Physiol. 294: G669-G678 [Abstract] [Full Text]  
• Imai, T., Fukuta, K., Hasumura, M., Cho, Y.-M., Ota, Y., Takami, S., Nakagama, H., Hirose, M. (2007). Significance of inflammation-associated regenerative mucosa characterized by Paneth cell metaplasia and {beta}-catenin accumulation for the onset of colorectal carcinogenesis in rats initiated with 1,2-dimethylhydrazine. Carcinogenesis 28: 2199-2206 [Abstract] [Full Text]  
• Sands, B. E., Kaplan, G. G. (2007). The Role of TNF{alpha} in Ulcerative Colitis. J Clin Pharmacol 47: 930-941 [Abstract] [Full Text]  
• Nazli, A., Wang, A., Steen, O., Prescott, D., Lu, J., Perdue, M. H., Soderholm, J. D., Sherman, P. M., McKay, D. M. (2006). Enterocyte Cytoskeleton Changes Are Crucial for Enhanced Translocation of Nonpathogenic Escherichia coli across Metabolically Stressed Gut Epithelia. Infect. Immun. 74: 192-201 [Abstract] [Full Text]  
• Rutgeerts, P., Sandborn, W. J., Feagan, B. G., Reinisch, W., Olson, A., Johanns, J., Travers, S., Rachmilewitz, D., Hanauer, S. B., Lichtenstein, G. R., de Villiers, W. J.S., Present, D., Sands, B. E., Colombel, J. F. (2005). Infliximab for Induction and Maintenance Therapy for Ulcerative Colitis. NEJM 353: 2462-2476 [Abstract] [Full Text]  
• (2005). Endoscopic Features in UC Predict Dysplasia. JWatch Gastroenterology 2005: 3-3 [Full Text]  
• Gibson, P R (2004). Increased gut permeability in Crohn's disease: is TNF the link?. Gut 53: 1724-1725 [Full Text]