Is Surveillance Endoscopy Necessary after Colectomy in Ulcerative Colitis?

Yasutaka Shuno,Tetsu Kojima,Giichiro Tsurita,Hirokazu Nagawa,Eiji Sunami,Masaru Shinozaki,Keisuke Hata,Nelson H Tsuno,Joji Kitayama,Masaya Hiyoshi,Kazushige Kawai

doi:10.5402/2011/509251

Abstract

The role of surveillance endoscopic followup in colectomized patients with long standing total colitis is controversial. Here, we aimed to clarify its usefulness for the early detection of dysplasia and cancer in this group of patients. Ninety-seven colectomised UC patients followedup by surveillance endoscopy were retrospectively investigated by reviewing the pathological reports. Patients had received either subtotal colectomy and ileo-rectal anastomosis (IRA) or total proctocolectomy and ileal anal anastomosis (IPAA). Definite dysplasia was diagnosed in 4 patients, who had received IRA; among them, 2 were carcinoma with submucosal invasion, and one was a high-grade dysplasia. Postoperative surveillance endoscopy is useful for the detection of early cancer in the remaining colonic mucosa of UC patients, and those receiving IRA, in which rectal mucosa is left intact, would be good candidates. However, its effectiveness for patients receiving IPAA, in which the rectal mucosa is resected, needs further investigation.

Highlights

Long-standing extensive ulcerative colitis (UC) is reported to be a risk factor for the development of colorectal cancer (CRC) [1,2,3]
Surveillance colonoscopy instead of prophylactic proctocolectomy is generally recommended for those with total colitis for more than 8 years after the onset or left-sided colitis for more than 15 years [4, 5]
4 patients who had received ileo-rectal anastomosis (IRA) were diagnosed as definite dysplasia (Table 1, Figure 2)

Summary

Introduction

Long-standing extensive ulcerative colitis (UC) is reported to be a risk factor for the development of colorectal cancer (CRC) [1,2,3]. Subtotal colectomy with ileo-rectal anastomosis (IRA) had been the surgical treatment of choice for UC until pouch operation was established, but patients undergoing subtotal colectomy have been reported to carry a certain risk of developing carcinoma in the rectal remnant [6, 7]. Total proctocolectomy eliminates the risk of colorectal cancer, several cases with cancer in the rectal remnant or ileal pouch have been reported. Stapled IPAA is a safer and less complicated method than handsewn IPAA, but the rectal remnant of a few centimeters may retain a malignant potential. Several cases of dysplasia or cancer in the ileal pouch have been reported after IPAA [15,16,17]

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Conclusion