Original Article
Long-term follow-up after polypectomy treatment for adenoma-like dysplastic lesions in ulcerative colitis

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Abstract

Background & Aims: A previously published study by our group suggested that adenoma-like dysplasia-associated lesions or masses (DALMs) in ulcerative colitis (UC) may be treated adequately by polypectomy and continued endoscopic surveillance. The length of follow-up evaluation in these patients averaged only 42 months. The purpose of this study was to evaluate the long-term outcome of our previously defined group of UC patients, all with adenoma-like DALMs, who were treated by polypectomy. Methods: The clinical, endoscopic, and pathologic outcome of 34 UC patients, 24 with an adenoma-like DALM, and 10 with a coincidental sporadic adenoma, 28 of whom were treated by polypectomy and continued endoscopic surveillance, and 6 by colonic resection, were compared with the outcome of 49 non-UC patients who were treated similarly for a sporadic adenoma. The mean length of follow-up evaluation averaged 82.1 months and 71.8 months for the 2 UC subgroups, respectively, and 60.4 months for the non-UC controls. Results: Overall, 20 of 34 UC patients (58.8%) developed at least one further adenoma-like DALM on follow-up evaluation. One patient had flat low-grade dysplasia present in the colon, which was resected within 6 months of the initial polypectomy, and another patient, with primary sclerosing cholangitis, developed adenocarcinoma 7.5 years after her initial polypectomy. There was no significant difference in the prevalence of polyp formation on follow-up evaluation between UC patients with an adenoma-like DALM (62.5%) and UC patients with a sporadic adenoma (50%), or between either of these 2 UC patient subgroups and the non-UC sporadic adenoma patient group (49%; P > 0.05). Conclusions: UC patients who develop an adenoma-like DALM may be treated adequately by polypectomy with complete excision and continued endoscopic surveillance.

Section snippets

Study group

The study group consisted of 34 UC patients, all of whom had at least one adenoma-like DALM detected during the course of endoscopic surveillance. These patients were the subjects of a previously published study by our research group.8 They originally were chosen by a retrospective search through the pathology files of the Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Boston, MA, between 1990 and 1995. These patients were stratified into 2 subgroups for the purpose of

Clinical and pathologic characteristics

A summary of the clinical and pathologic features of the UC and control patients is presented in Table 1. Table 1 was reproduced from our previously published report that used the same cohort of UC patients and controls. Overall, the 34 UC patients and the 49 non-UC control patients showed a statistically similar distribution of polyps, mean polyp size, prevalence of high-grade dysplasia, and prevalence of a villous, or tubulovillous, growth pattern. Of the 34 UC patients, 12 (35%), 14 (41%),

Discussion

DALMs are a heterogeneous group of lesions that have varying endoscopic and morphologic features.5, 6 Recently, we proposed a clinically useful classification of DALMs into 2 broad groups (adenoma-like and non—adenoma-like), which is based on their gross (endoscopic) appearance.5 The main clinical difference between these 2 groups relates to their different risk for malignancy. It is well known that non—adenoma-like DALMs have up to an 80% risk for either metachronous or synchronous occurrence

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