Cancer surveillance colonoscopy in ulcerative colitis: sense or nonsense?

Surveillance in patients at risk for the development of cancer in the setting of ulcerative colitis is a common part of the management of these patients. There is controversy as to the efficacy of surveillance, the key issues relating to cost and reduction of cancer risk. Colonoscopic surveillance makes sense when it can be shown to detect cancers at a curable stage or be used to prevent cancer. The use of "low grade dysplasia" as an indication for early colectomy may have a favorable impact on survival statistics. The costs for surveillance compared favorably to the costs for flexible sigmoidoscopy surveillance for colo-rectal cancer. The negative answer to the question relates to studies suggesting that the cancer risk is overestimated and that "low-grade" dysplasia is of little prognostic value. Advocates of this policy recommend a non-surveillance or "follow-up" program. Two approaches that may improve efficacy are to target the high risk population for an increased frequency of surveillance and to enhance the accuracy of the dysplasia marker. Studies with flow cytometry are encouraging with DNA aneuploidy in colonic biopsies shown to have predictive value for the development of dysplasia in ulcerative colitis. Overall, surveillance seems warranted due to the risk, fear of cancer among patients, and the excess mortality among the entire inflammatory bowel disease population. The availability of the newer molecular tools could provide improvement in the surveillance approach.