The Efficacy of Surveillance

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 [23]. Other studies, however, are less convincing [24], 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 [25], and a review reported on in the Cochrane Central Register of Controlled Trials presents a similar message [18]. 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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