Clinical–alimentary tractHistologic Inflammation Is a Risk Factor for Progression to Colorectal Neoplasia in Ulcerative Colitis: A Cohort Study
Section snippets
Materials and Methods
Following approval by The Mount Sinai School of Medicine Institutional Review Board and in accordance with Health Insurance Portability and Accountability Act guidelines, our research group established a UC surveillance database. This database contains all patients in the Mount Sinai Hospital gastrointestinal pathology and surgical pathology registries who had undergone at least 1 surveillance colonoscopy between January 1996 and December 1997, a period chosen to allow for long-term follow-up.
Results
Of 543 UC patients who underwent surveillance colonoscopy between 1996 and 1997, 125 patients were excluded for having dysplasia at their first colonoscopy at our institution, lack of histologic follow-up, or prior colorectal surgery, leaving a cohort of 418 patients with no initial dysplasia. The demographic characteristics of the cohort and their surveillance patterns and medication use are provided in Table 2. Over 90% of patients had extensive colitis, and the median duration of UC was 16
Discussion
Few studies have addressed the severity of colonic inflammation over time as an independent risk factor for progression to neoplasia. Two attempts to determine whether the risk of CRC was associated with frequency of clinical exacerbations found no such relationship.19, 20 Rutter et al, however, successfully demonstrated a correlation between histologic inflammation and neoplastic progression in a case-control study involving 68 cases and 136 matched controls.13 They also showed that endoscopic
References (32)
- et al.
Diagnosis and management of dysplasia in patients with inflammatory bowel diseases
Gastroenterology
(2004) - et al.
Factors affecting the outcome of endoscopic surveillance for cancer in ulcerative colitis
Gastroenterology
(1994) - et al.
Surveillance in the routine management of ulcerative colitis: the predictive value of low-grade dysplasia
Gastroenterology
(1992) - et al.
Performing a cost-effectiveness analysis: surveillance of patients with ulcerative colitis
Am J Gastroenterol
(1998) - et al.
How gastroenterologists screen for colonic cancer in ulcerative colitis: an analysis of performance
Gastrointest Endosc
(2000) - et al.
Observer study of the grading of dysplasia in ulcerative colitis: comparison with clinical outcome
Hum Pathol
(1989) - et al.
Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis
Gastroenterology
(2004) - et al.
Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications
Hum Pathol
(1983) - et al.
Risk factors for colorectal cancer in patients with ulcerative colitis: a case-control study
Gastroenterology
(1994) - et al.
The fate of low-grade dysplasia in ulcerative colitis
Am J Gastroenterol
(2002)
Progression of flat low-grade dysplasia to advanced neoplasia in patients with ulcerative colitis
Gastroenterology
Polypectomy may be adequate treatment for adenoma-like dysplastic lesions in chronic ulcerative colitis
Gastroenterology
Colonoscopic polypectomy in chronic colitis: conservative management after endoscopic resection of dysplastic polyps
Gastroenterology
The risk of colorectal cancer in ulcerative colitis: a meta-analysis
Gut
Ulcerative colitis and colorectal cancerA population-based study
N Engl J Med
Failure of colonoscopic surveillance in ulcerative colitis
Gut
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There are no conflicts of interest to disclose in relation to this manuscript.
Supported by grants from the Doris Duke Foundation (to R.B.G. and S.M.), the American College of Gastroenterology (to T.U.), and the National Institutes of Health (K-08-DK069393; to T.U.)