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LAKE TAHOE, CALIF. — The frequency of colonoscopies to screen for cancer in patients with Crohn's disease colitis or ulcerative colitis should be based on how long they've had colitis, Dr. Joshua R. Korzenik said at a meeting on gastroenterology and hepatology sponsored by the University of California, Davis.
But if a colonoscopy can answer an important clinical question facing the patient today, it should be done now regardless of the colitis duration, said Dr. Korzenik, codirector of the Crohn's and Colitis Center at Massachusetts General Hospital, Boston.
Without that pressing motivation, a screening colonoscopy typically would be appropriate every 3–4 years during the first decade of a patient's Crohn's or ulcerative colitis. Because these patients can develop cancer not only from polyps but from flat, normal-appearing mucosa, multiple biopsies are needed. A minimum of 33 biopsies should be taken, spaced about every 4–10 cm throughout the colon.
“That has about a 90% likelihood of picking up dysplasia,” he said.
For patients with a disease duration of 10–20 years, colonoscopy should be performed every other year. For those with a disease duration longer than 20 years, annual colonoscopy is preferred.
“We're beginning to move toward chromoendoscopy, where we spray the colon with a contrast material that picks up dysplasia a little bit better,” he added.
If the colonoscopy detects high-grade dysplasia, the patient should undergo a colectomy, Dr. Korzenik advised.
LAKE TAHOE, CALIF. — The frequency of colonoscopies to screen for cancer in patients with Crohn's disease colitis or ulcerative colitis should be based on how long they've had colitis, Dr. Joshua R. Korzenik said at a meeting on gastroenterology and hepatology sponsored by the University of California, Davis.
But if a colonoscopy can answer an important clinical question facing the patient today, it should be done now regardless of the colitis duration, said Dr. Korzenik, codirector of the Crohn's and Colitis Center at Massachusetts General Hospital, Boston.
Without that pressing motivation, a screening colonoscopy typically would be appropriate every 3–4 years during the first decade of a patient's Crohn's or ulcerative colitis. Because these patients can develop cancer not only from polyps but from flat, normal-appearing mucosa, multiple biopsies are needed. A minimum of 33 biopsies should be taken, spaced about every 4–10 cm throughout the colon.
“That has about a 90% likelihood of picking up dysplasia,” he said.
For patients with a disease duration of 10–20 years, colonoscopy should be performed every other year. For those with a disease duration longer than 20 years, annual colonoscopy is preferred.
“We're beginning to move toward chromoendoscopy, where we spray the colon with a contrast material that picks up dysplasia a little bit better,” he added.
If the colonoscopy detects high-grade dysplasia, the patient should undergo a colectomy, Dr. Korzenik advised.
LAKE TAHOE, CALIF. — The frequency of colonoscopies to screen for cancer in patients with Crohn's disease colitis or ulcerative colitis should be based on how long they've had colitis, Dr. Joshua R. Korzenik said at a meeting on gastroenterology and hepatology sponsored by the University of California, Davis.
But if a colonoscopy can answer an important clinical question facing the patient today, it should be done now regardless of the colitis duration, said Dr. Korzenik, codirector of the Crohn's and Colitis Center at Massachusetts General Hospital, Boston.
Without that pressing motivation, a screening colonoscopy typically would be appropriate every 3–4 years during the first decade of a patient's Crohn's or ulcerative colitis. Because these patients can develop cancer not only from polyps but from flat, normal-appearing mucosa, multiple biopsies are needed. A minimum of 33 biopsies should be taken, spaced about every 4–10 cm throughout the colon.
“That has about a 90% likelihood of picking up dysplasia,” he said.
For patients with a disease duration of 10–20 years, colonoscopy should be performed every other year. For those with a disease duration longer than 20 years, annual colonoscopy is preferred.
“We're beginning to move toward chromoendoscopy, where we spray the colon with a contrast material that picks up dysplasia a little bit better,” he added.
If the colonoscopy detects high-grade dysplasia, the patient should undergo a colectomy, Dr. Korzenik advised.