• screening
• cancer surveillance
• colorectal cancer
• ulcerative colitis

We would like to voice our concerns about some of the recommendations in the guidelines recently published by the British Society of Gastroenterology and Association of Coloproctology for screening and surveillance for asymptomatic colorectal cancer in patients with inflammatory bowel disease (Gut 2002;51 (suppl V):v10–12).

(1) In the present medicolegal environment, failure to comply with guidelines which carry the imprimatur of respected national bodies will require vigorous defence should mishap occur. We do not believe the evidence is strong enough to justify the recommendation that every patient with extensive colitis of duration greater than 8–10 years should undergo regular colonoscopy. Firstly, it must be determined at each hospital whether it is possible and considered sufficiently cost effective to offer such a service within the constraint of local resources available. Secondly, if regular colonoscopy can be offered, then each patient should decide whether or not to accept regular colonoscopy after full discussion of its possible advantages and limitations.

(2) The success of colonoscopic surveillance programmes is disputed. Although some centres (including our own) have been protagonists for this approach, others have argued that it is not only labour intensive but also ineffective. Before imposing global national guidelines we should have firm evidence of a scheme’s efficacy or, failing this, we should have multicentre consensus. The guidelines, as published, appear to be the sincerely held opinions of a single consultant team based on their own research and assessment of the literature, followed by approval of a committee, but no indication is given of widespread consultation.

(3) The recommendations for patients with extensive colitis of a colonoscopy every third year during the second decade of disease, every second year during the third decade, and annual colonoscopies thereafter are complex. The evidence for an increasing risk of cancer in the second, third, and …