7070 Endoscopic follow-up study of ulcerative colitis with skipped appendiceal involvement.

Abstract

Background and aims : Recently it has been reported that appendiceal involvement can occur as a skip lesion in ulcerative colitis (UC), although the clinical significance of this finding is still debatable. In such cases, we evaluated the changes in disease extent endoscopically and histologically, and also assessed the presence of appendiceal orifice (AO) inflammation. Materials and methods : From January 1993 to August 1999, a total of 17 patients with skipped AO involvement were entered into this study with their informed consent. All of them received medical therapy, and colonoscopy was performed twice or more at intervals of more than 3 months. Results : The patients with endoscopically skipped AO involvement were divided into two groups with respect to disease extent; 6 (3M, 3F; median age at disease onset 36 yr; range 20-65 yr) showed fixed areas that were spared endoscopically and histologically (S-type), and 11 (8M, 3F; 23 yr; range 13-46 yr) showed endoscopically active lesions in some areas at some time, histological examination revealing continuous pancolitis (C- type). The median follow-up periods were 23.7 (range 12-39) months for the Stype and 29 (3-47) months for the C-type. The median times of colonoscopic examinations were 4 (2-6) and 4 (2-8) months,respectively. The transverse colon was affected significantly less frequently in the S-type than in the C-type (p=0.03). There was a close correlation (p=0.005) between the activity of AO and that of the main lesion in the S-type, but not in the Ctype. Conclusion :Cases of UC with endoscopically skipped AO lesions were divided into two types; those showing histological skipping and those showing histological continuity. In the S-type, AO inflammation was correlated with the activity of the main lesions, and active lesions were rarely found in the transeverse colon. In the C-type, although histological continuity was evident, relapse as pancolitis seldom or never occurred.