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THE UTILITY AND SIGNIFICANCE OF RIGHT COLON BIOPSIES OBTAINED DURING SURVEILLANCE FOR COLON CANCER IN LONG STANDING LEFT SIDED ULCERATIVE COLITIS; A RETROSPECTIVE REVIEW
M Shawesh, R Sy
Division of Gastroenterology, University of Ottawa, Ottawa, Ontario
AIM: Current colon cancer surveillance guidelines for left sided ulcerative colitis with more than 12 years duration include taking biopsies from every 10 cm in all 4 quadrants of the entire colon regardless of involvement of the right side of the colon (defined as colon beyond splenic flexure) with colitis. It is uncertain what the utility of taking right sided biopsies if there is no active disease. Presumably the incidence of cancer/dysplasia should be less than that of the left side. The aim of this study is to determine whether there is any utility in taking right sided biopsies for dysplasia in ulcerative colitis that is predominantly left sided.
METHOD: A retrospective chart review of patients who have had left sided ulcerative colitis for over 12 years and are in a surveillance program for colon cancer was reviewed from Sept 2002 to Sept 2007. 25 patients met the above mentioned criteria. Demographic data, findings on colonoscopic examination and pathology reports was recorded.
RESULTS: Of the 25 patients, 12 (48%) were males, the mean age was 55 years (range 45-80), 22 (88%) were on a 5-ASA agent, 3 (12%) were smokers, 0% had PSC and 1 (4%) had family history of colon cancer. All 25 patients had left sided inflammation. 32% had right sided inflammation despite normal endoscopic features on the right side. 4% had low grade dysplasia on the left colon. None of the patients had right sided dysplasia. No patients had cancer.
CONCLUSION: No dysplasia or cancer was detected on the right colon of patients with left sided colitis. Dysplasia was detected in left colon in one patient. Although no dysplasia was detected on the right colon, there was evidence of right colonic inflammation on biopsy suggesting a possibility that dysplasia can occur. This study suggests that the current surveillance guidelines for colon cancer in patients with left sided colitis should include obtaining biopsies from the entire colon.