Colonoscopic surveillance in long-standing total ulcerative colitis--a 15-year follow-up study

Gastroenterology. 1990 Oct;99(4):1021-31. doi: 10.1016/0016-5085(90)90622-8.


In a 15-year surveillance program composed of 72 patients with total ulcerative colitis, 12 patients developed definite dysplasia. At endoscopy, low-grade dysplasia was detected in seven patients, high-grade in four, and a carcinoma (Dukes' stage A at operation) in one. One of the patients with high-grade dysplasia and macroscopical lesions at colonoscopy had a carcinoma (Dukes' A) detected at operation. A sequential development of dysplasia was found in seven patients. The cumulative risk of developing at least low-grade dysplasia was 14% after 25 years of disease duration. Using flow cytometric analyses, abnormal, aneuploid DNA content was detected in biopsies of 12 of 59 patients (20.3%); this correlated significantly with low-grade and high-grade dysplasia. Aneuploidy preceded dysplasia in two patients and was also detected in two dysplasia-free patients. The long-term use of colonoscopic surveillance in ulcerative colitis is a reliable way to select patients, in whom dysplasia is developing, for prophylactic surgery. Additionally, flow cytometric DNA analyses may help in the selection. The risk of missing a carcinoma until it becomes incurable appears to be low.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aneuploidy
  • Colitis, Ulcerative / pathology*
  • Colon / pathology*
  • Colonoscopy
  • Colorectal Neoplasms / epidemiology
  • Flow Cytometry
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Population Surveillance
  • Risk Factors
  • Time Factors