궤양성 대장염에서 대장암 위험 인자와 대장내시경 추적 감시 검사

What's New

Ulcerative colitis and colorectal cancer risk (February 2020)

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The risk of colorectal cancer (CRC) in patients with ulcerative colitis (UC) depends on several factors, including disease extent and duration. In a large, population-based cohort study of patients with UC, those with extensive colitis (ie, disease extending beyond the splenic flexure) had increased CRC risk compared with age- and sex-matched controls (521 versus 343 cases of CRC per 1000 person-years). In contrast, CRC risk was not increased in patients with ulcerative proctitis or left-sided colitis. For patients with extensive UC, we initiate colonoscopy surveillance for colorectal dysplasia eight years after disease or symptom onset, and these data support our approach.

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Patient selection and timing — In all patients with ulcerative colitis and Crohn disease involving one-third of the colon or more, we recommend a screening colonoscopy eight years after disease or symptom onset to initiate surveillance for colorectal neoplasia.Surveillance remains the standard of care, although reduction in mortality due to surveillance has not been clearly established.

 

At the time of surveillance colonoscopy, we also obtain histologic staging biopsies to assess mucosal healing and the extent of disease activity.

 

We also recommend initial screening colonoscopy at eight years after disease onset for patients with isolated proctitis or disease involving less than one-third of the colon, to reassess disease extent as colitis may progress over time. In a study of a pathology database, the diagnosis of colorectal cancer (CRC) was delayed or missed in 17 to 35 percent of inflammatory bowel disease patients when screening was delayed until 8 to 10 or even 15 years, prompting many societies to adopt a shorter duration of disease at which to recommend starting surveillance.

 

Initiation of screening is recommendedat the time of diagnosis in patients with a history of primary sclerosing cholangitis.Screening can be discussedwith patients with a strong family history of CRC (ie, first-degree relative diagnosed before age 50) and offered depending on the age and preference of patient

 

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REF

UpToDate 2020.03.09

2020.03 대한소화기내시경학회 진료지침

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