Results of cancer surveillance in ulcerative colitis

A total of 144 patients with total or left-sided colitis of 7 years or more duration were enrolled in a surveillance program to screen for dysplasia at Tokyo University Hospital between 1979 and 1994. The program consisted of an annual colonoscopy, with multiple biopsies being performed at 10-cm intervals in the colonic flat mucosa; additional biopsies were taken from elevated lesions. A higher proportion of patients who had had four surveillance colonoscopies or more up to the detection of carcinoma had an earlier stage of carcinoma compared with patients who had had less than three colonoscopies. In addition, the incidence and stage of carcinoma were higher in the patients with an initially higher grade of dysplasia and in those patients with elevated lesions compared with patients with flat mucosal lesions with the same grade of dysplasia. Microspectrophotometric DNA analysis was performed for 66 consecutive patients who had been under surveillance between 1987 and 1990. Dysplasia and carcinoma occurred at a higher rate in patients who had an initial abnormal DNA content compared with patients who showed diploidy. These findings indicate that surveillance colonoscopy with DNA analysis could be useful in the early detection of colonic carcinoma in long-standing ulcerative colitis.