Surveillance For Colorectal Neoplasia Research Articles

Screening and surveillance for colorectal neoplasia: uncertainties of colonoscopic management

Over the past decade the use of screening and surveillance modalities has been associated with a small but significant decrease in the incidence of colorectal cancer and an increase in curability of lesions that are found. Although consensus-based international guidelines have stressed the variety of possible diagnostic options that can serve this purpose, in many countries colonoscopy withremoval of all polyps has become the test of choice. The evidence-base for this choice is largely derivative rather than direct and prospective, and many uncertainties remain in its use as a primary screening modality. This review examines our current guidelines relative to risk stratifying the populations offered the test; the onset, interval, and discontinuation of testing; and the important role of operator variability in outcome.

Attendance at surveillance endoscopy of patients with adenoma or colorectal cancer

Objective. Surveillance of patients treated for adenoma or colorectal cancer (CRC) is intended to reduce the incidence of CRC. Responsibility for the adherence to surveillance advice is often left to the patients and family physician. It is not known whether this type of passive policy affects the efficacy of surveillance. The aim of this study was to determine the yield of surveillance without active invitation to follow-up endoscopy. Material and methods. The study comprised a cohort follow-up of patients under 75 years of age with adenomas or CRC at index endoscopy in the period 1997–99. Adherence and intervals of follow-up endoscopy were determined up to December 2004. Results. During the inclusion period 2946 patients underwent lower endoscopy. In total, 393 patients were newly diagnosed with colorectal polyps (n=280) or CRC (n=113). Polyps were classified as adenomas in 167/280 (61%) patients. Forty-five (27%) of the adenoma patients underwent surveillance endoscopy within the guideline interval, 63 (38%) underwent delayed endoscopy, and 59 (35%) did not have any follow-up at all. CRC was diagnosed in 113 patients. Thirty-six patients who died during the first year or were diagnosed with metastases were excluded from the analysis. Twenty-three (30%) of the remaining 77 patients underwent endoscopic surveillance according to the guidelines, 40 (52%) had delayed surveillance endoscopy, and 14/77 (18%) did not undergo surveillance endoscopy at all. Conclusions. In surveillance for colorectal neoplasia, active follow-up invitation is important. Given the low follow-up rate in our series, passive follow-up policies may lead to underperformance of surveillance programs. An active and controlled follow-up is advisable.

Endoscopic surveillance for colorectal neoplasia.

Journal Article Endoscopic surveillance for colorectal neoplasia Get access A D Spigelman A D Spigelman Academic Surgical Unit, St Mary's Hospital Medical School, London W21NY, UK Correspondence to: Mr A. D. Spigelman, Academic Surgical Unit, St Mary's Hospital Medical School, London W21NY, UK Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 81, Issue 11, November 1994, Pages 1664–1665, https://doi.org/10.1002/bjs.1800811135 Published: 14 December 2005 Article history Accepted: 30 March 1994 Published: 14 December 2005

Magnification endoscopy, chromoendoscopy and other novel techniques in evaluation of patients with IBD

Magnification endoscopy and chromoendoscopy are two new endoscopic techniques which have been introduced into clinical practice over the past decade with uses in patients both with and without inflammatory bowel disease. Specific uses for these techniques in patients without inflammatory bowel disease include evaluating for celiac sprue and tropical sprue, detection of squamous cell esophageal cancer, detection of Barrett’s esophagus and its associated neoplasia, as well as assisting in the detection of colorectal neoplasia for which specific pit pattern appearances have been described. In patients with ulcerative colitis, magnification endoscopy and chromoendoscopy have been shown to significantly increase the overall detection of colorectal neoplasia, particularly in flat colorectal lesions, as compared with conventional endoscopy. In addition, pit pattern analysis has allowed these techniques to be highly accurate in predicting neoplasia at histology. Thus, with magnification endoscopy and chromoendoscopy, targeted biopsy during colorectal neoplasia surveillance in ulcerative colitis may become feasible in the not too distant future. Finally, magnification endoscopy and chromoendoscopy have been shown to be significantly more accurate than conventional endoscopy in predicting the extent of ulcerative colitis and in predicting mild histologic disease. These techniques do not appear to be helpful in predicting severe histologic disease, and it is unclear at this time if they will be useful for predicting moderate histologic disease. Specific trials using magnification endoscopy and chromoendoscopy to predict response to therapy have not yet been done to determine whether these findings will translate into any significant clinical advantage.

Colorectal neoplasia in juvenile polyposis or juvenile polyps.

Juvenile (retention) polyps are usually solitary lesions in the colorectum but may be multiple in juvenile polyposis. The association between juvenile polyps and colorectal neoplasia is controversial. We present three patients with juvenile polyposis who had colorectal adenomas or adenomatous epithelium in juvenile polyps at ages 3, 4, and 7 years. In a retrospective study of 57 additional patients with one or more juvenile polyps, 10 patients (18%) had colorectal neoplasia including three with adenocarcinoma, two with tubular adenoma, and six with adenomatous epithelium in a juvenile polyp (one had both adenomatous epithelium and an adenocarcinoma). Nine of these 10 patients had juvenile polyposis defined by the presence of at least three juvenile polyps; and eight of the nine had a family history of juvenile polyps. Colorectal neoplasia occurred at young age (mean (SEM) 37 (5) years). Our findings suggest that patients with juvenile polyps who have three or more juvenile polyps or a family history of juvenile polyps should undergo surveillance for colorectal neoplasia.