| [ Summary ] |
It is widely accepted that long standing cases of ulcerative colitis, especially pancolitis, have a higher risk of complicating colitic cancer. Since colitic cancer is often accompanied by poorly differentiated types of adenocarcinoma, multifocal progression of tumors and a tendency toward early invasion, detection of neoplastic changes in the earlier stages is an important issue.
To properly diagnose precancerous dysplastic lesions in such patients, annual surveillance colonoscopy for high risk groups has been recommended. Meta analysis showed that patients with pancolitis, with complications from primary sclerosing cholangitis, disease duration over 10 years, onset at a younger age and a family history of colorectal cancer are at a higher risk of developing colitic cancer compared with other groups having ulcerative colitis. Surveillance colonoscopy, treatment with 5-aminosalicylates (chemoprevention) has prevented the development of colitic cancer. In the western world, annual surveillance colonoscopy with multiple stepwise has been adopted. However, there are potential risks with such methods for inducing relapse. In Japan, surveillance colonoscopy with targeted biopsies has proven to be efficacious in finding dysplastic lesions. Magnifying endoscopy may improve the sensitivity of the procedure. |