Endoscopic features and clinical course of patients with asymptomatic cecal ulcers

Abstract

BackgroundCecal ulcers aresometimes encountered in asymptomatic individuals. Their clinical outcomes andmanagement recommendations remain uncertain.MethodsAsymptomatic patients who underwent a colonoscopic examfor colon cancer screening were retrospectively reviewed from July 2009 toNovember 2016. Patients with cecal ulcers were included. Patients who hadcolorectal symptoms, such as abdominal pain, had nonsteroidal anti-inflammatorydrugs or were lost to follow-up were excluded.ResultsA total of 34,036 patients underwent colon cancerscreening. Cecal ulcers were found in 35 patients. After exclusion, 24 patients(mean duration, 52 months) received follow-up colonoscopy. In 20 patients,(83.3%), cecal ulcer resolved without intervention, but 4 patients (16.7%)developed clinical significant diseases, including intestinal tuberculosis(n = 2), Crohn’s disease (n = 1), and ulcerative colitis (n = 1). Patients whodeveloped clinically significant diseases had a higher percentage of ulcerslarger than 1 cm (75% vs. 15%, p = 0.035), terminal ileum involvement (100% vs.15.4%, p = 0.006) and ulcers with irregular fold (75% vs. 5%, p = 0.008).ConclusionsIn patients withasymptomatic cecal ulcers, the endoscopic features included larger ulcer size,terminal ileum involvement and ulcers with irregular fold may predictdevelopment of clinically significant diseases. If the above-mentioned featuresare present, even asymptomatic patients should be closely monitored.