NEW YORK (Reuters Health), Aug 4 - Endoscopic resection is adequate treatment for sporadic adenomas that arise in patients with ulcerative colitis, according to a report in the August issue of Gut.
"Sporadic adenoma can be removed by polypectomy, whereas for colitis-associated neoplasia, proctocolectomy is indicated" according to guidelines, Dr. Michael Vieth from Klinikum Bayreuth GmbH, Bayreuth, Germany told Reuters Health. "This means that unnecessary proctocolectomies can be theoretically avoided."
Dr. Vieth and colleagues investigated whether endoscopic resection of an adenoma in ulcerative colitis truly represents adequate therapy or whether proctocolectomy is mandatory.
In 87 of 148 consecutive patients, the adenoma was removed completely by endoscope, the authors report. No further neoplasias developed in 83 of these patients after a mean follow-up of 53 months.
Four of the 87 endoscopically treated patients developed a low-grade intraepithelial neoplasia during follow-up, but these lesions were located in another segment of the colon. Two of these patients subsequently developed a colitis-associated adenocarcinoma, but remained recurrence and metastasis free 17 and 83 months, respectively, after their proctocolectomies.
Among the 60 patients who did not undergo endoscopic treatment, 31 developed no further neoplasias during the mean 87 months of follow-up, the researchers note. In contrast, 29 of these patients (48.3%) developed an ulcerative colitis associated neoplasia in the same segment of the colon previously containing the adenoma.
Nineteen of 20 patients with ulcerative colitis-associated neoplasia who underwent proctocolectomy remained tumor free for the rest of the observation period (mean, 97 months), the report indicates, and one patient with high-grade intraepithelial neoplasia died 46 months after surgery (colorectal carcinoma had been detected in the surgical specimen).
Nine patients with endoscopically diagnosed colitis associated carcinoma remained recurrence- and metastasis-free throughout follow-up, the results indicate.
"Our results, established in the largest number of patients with adenoma in ulcerative colitis to date, and over a relative long follow-up period (six years on average) with endoscopy/biopsy examinations, showed that endoscopic resection of these adenomas represents adequate treatment, and that proctocolectomy, often previously applied in such patients, must therefore be considered overtreatment," the authors conclude.
Last Updated: 2006-08-03 16:31:58 -0400 (Reuters Health)
Gut 2006;55:1151-1155.
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