There is evidence showing that colonoscopic surveillance may detect precancerous dysplasia and early treatable cancer. Thus, some studies indicate that patients with cancers detected by surveillance tend to be at a curable stage while patients not adhering to surveillance are most likely to die from cancer . Other studies, however, are less convincing , showing evidence that only very few of the malignancies found were treatable cancers detected by true surveillance colonoscopy and with only a marginally better success rate. There seems in fact to be no direct evidence that endoscopic surveillance reduces cancer mortality in inflammatory bowel disease , and a review reported on in the Cochrane Central Register of Controlled Trials presents a similar message . Although cancers tend to be detected at an earlier stage and has a correspondingly better prognosis in patients who are undergoing surveillance, lead-time bias seems to contribute substantially to this apparent benefit; and there is no clear evidence that surveillance colonoscopy prolongs survival in patients with extensive colitis. Nevertheless, there seems to be consensus that a surveillance programme should offer colonoscopy to patients with extensive ulcera-tive colitis of 8 years duration and to those with less extensive disease of 15 years duration. Surveillance colonoscopy should be performed every 3 years for 10 years, every 2 years for 10 and then annually including at least four biopsies taken every 10 cm around the colon with careful biopsy of any macroscopic lesion.
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