IBD: Management of Dysplasia in Patients with Ulcerative Colitis
The risk of colorectal cancer (CRC) in the ulcerative colitis (UC) population is real and is the cause of death for up to 15 % of inflammatory bowel disease (IBD) patients. Controversy surrounds the use of prophylactic colectomy when dysplasia is detected
- PDF / 252,002 Bytes
- 14 Pages / 439.37 x 666.142 pts Page_size
- 34 Downloads / 227 Views
IBD: Management of Dysplasia in Patients with Ulcerative Colitis Tara M. Connelly and Walter A. Koltun
Introduction The risk of colorectal cancer (CRC) in the ulcerative colitis (UC) population is real and is the cause of death for up to 15 % of inflammatory bowel disease (IBD) patients [1, 2]. Controversy surrounds the use of prophylactic colectomy when dysplasia is detected. The relatively high risk of progression to CRC must be weighed against the risks associated with total proctocolectomy (TPC) ± ileal pouch anal anastomosis (IPAA), which, in contrast, are relatively low, particularly when performed in an elective setting and by an experienced surgeon. In addition to substantially reducing the CRC risk, TPC results in the elimination of future UC flares and the necessity for medical treatment whilst eliminating the need for frequent CRC surveillance. As more powerful techniques for lesion detection become widespread, the detection of dysplasia will likely increase, increasing the relevance of the question ‘What is the most appropriate management of patients with ulcerative colitis and dysplasia?’
T.M. Connelly, MB, BCh, PhD Department of Surgery, Waterford University Hospital, Waterford, Ireland W.A. Koltun, MD, FRCS, FASCRS (*) Division of Colon and Rectal Surgery, Inflammatory Bowel Disease, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA e-mail: [email protected]
© Springer International Publishing Switzerland 2017 N. Hyman, K. Umanskiy (eds.), Difficult Decisions in Colorectal Surgery, Difficult Decisions in Surgery: An Evidence-Based Approach, DOI 10.1007/978-3-319-40223-9_10
83
84
T.M. Connelly and W.A. Koltun
Search Strategy The PubMed database was searched using the following terms ‘dysplasia, carcinoma, neoplasia, DALM, ALM, dysplasia associated mass or lesion, adenoma like lesion or mass and ulcerative colitis or inflammatory bowel disease or IBD.’ The search was limited to full length English language manuscripts published between Jan 1, 1980 and Oct 1, 2015. All references in each manuscript identified from the PubMed search were then individually reviewed and examined for relevance and potential inclusion.
Results Patients, interventions, comparator and outcomes are highlighted in Table 10.1. The most salient studies reviewed are shown in Table 10.2.
Incidences of Dysplasia and Colorectal Cancer (CRC) Studies on UC dysplasia typically provide incidence rates obtained from the use of conventional endoscopy. Any grade of dysplasia is found in up to 2 % of UC patients at 5 years and 33 % at 15 years [4, 18]. Ten and 15 year rates of high grade dysplasia (HGD) of 7 % and 12 % respectively have been reported. Similar to CRC, incidence is highest in patients with pancolitis [15]. Median time from UC diagnosis to CRC diagnosis varies from 4 to 23 years [4, 19]. Compared to the general population, the relative risk of CRC in UC patients is as high as 16-fold [20]. Meta-analysis inclusive of 116 studies has demonstrated an overall pr
Data Loading...
