Further validation of high-magnification chromoscopic-colonoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis

Hurlstone, David P.; McAlindon, Mark E.; Sanders, David S.; Keogh, Rachel J.; Lobo, Alan; Cross, Simon S.

doi:10.1053/j.gastro.2003.05.021

Cited by 128 publications

(65 citation statements)

References 12 publications

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“…Furthermore, areas of microscopic infl ammation, without history of macroscopic infl ammation may also harbor the risk of neoplasia proximal to known macroscopic disease ( 58,367,373 ). ( 399,400 ). Th ese series have reported detection rates of dysplasia 1.5-to 5-fold greater than standard white light colonoscopy by endoscopists trained in the use of these techniques ( 399 -401 ).…”

Section: Recommendations For Cancer Surveillancementioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,141

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: Recommendations For Cancer Surveillancementioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,141

977

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“…Hurlstone et al [60] also emphasized high correspondence between pit pattern using HMCC and histopathology in ulcerative colitis. However, UC-associated colorectal cancer arises in the particular environment of ulcerative colitis, and slight deviations in pit pattern of the mucosa may be difficult to distinguish from epithelial regeneration.…”

Section: Ando T Et Al Magnifying Chromoscopy In Ucmentioning

confidence: 97%

“…The American Society for Gastrointestinal Endoscopy Guidelines advise taking two to four non-targeted biopsies for every 10 cm of colon and rectum [56] . It is still believed that dysplasia is invisible at endoscopy [57] , but some reports state that magnifying chromoscopic examination is useful for detecting that occurring in ulcerative colitis [58][59][60] . Kiesslich et al [61] reported that methylene blueaided chromoendoscopy in UC surveillance was about three times more useful than conventional colonoscopy for detecting dysplasia, while Rutter et al [58] reported the usefulness of pancolonic indigo carmine dye spraying.…”

Section: What Is Effective Surveillance Colonoscopy?mentioning

confidence: 99%

“…Careful mucosal examination aided by pancolonic chromoendoscopy and targeted biopsy of suspicious lesions may therefore represent a more effective surveillance methodology than the taking of multiple nontargeted biopsies [58] . Further, Hurlstone et al [60] observed intraepithelial neoplasia (IN) in flat mucosal change in 37 lesions, of which 31 (84%) were detected using HighMagnification-Chromoscopic-colonoscopy (HMCC), and HMCC significantly increased diagnostic yield for IN compared to conventional colonoscopy (P ＜ 0.01).…”

Section: What Is Effective Surveillance Colonoscopy?mentioning

confidence: 99%

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Magnifying chromoscopy, a novel and useful technique for colonoscopy in ulcerative colitis

Ando

Takahashi²,

Watanabe³

et al. 2007

WJG

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Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by exacerbations and remissions. The degree of inflammation as assessed by conventional colonoscopy is a reliable parameter of disease activity. However, even when conventional colonoscopy suggests remission and normal mucosal findings, microscopic abnormalities may persist, and relapse may occur later. Patients with long-standing, extensive ulcerative colitis have an increased risk of developing colorectal cancer. Ulcerative colitis-associated colorectal cancer is characterized by an early age at onset, poorly differentiated tumor cells, mucinous carcinoma, and multiple lesions. Early detection of dysplasia and colitic cancer is thus a prerequisite for survival. A relatively new method, magnifying chromoscopy, is thought to be useful for the early detection and diagnosis of dysplasia and colitic cancer, as well as the prediction of relapse.

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“…Inflammation usually occurs in the rectum and lower part of the colon, but it may affect the entire colon [1][2][3][4] . UC rarely affects the small intestine except for the end section, called the terminal ileum.…”

Section: Introductionmentioning

confidence: 99%

Drug therapy for ulcerative colitis

Meng²,

Pan³

2004

WJG

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Ulcerative colitis (UC) is an inflammatory destructive disease of the large intestine occurred usually in the rectum and lower part of the colon as well as the entire colon. Drug therapy is not the only choice for UC treatment and medical management should be as a comprehensive whole. Azulfidine, Asacol, Pentasa, Dipentum, and Rowasa all contain 5-aminosalicylic acid (5-ASA), which is the topical anti-inflammatory ingredient. Pentasa is more commonly used in treating Crohn's ileitis because Pentasa capsules release more 5-ASA into the small intestine than Asacol tablets. Pentasa can also be used for treating mild to moderate UC. Rowasa enemas are safe and effective in treating ulcerative proctitis and proctosigmoiditis. The sulfafree 5-ASA agents (Asacol, Pentasa, Dipentum and Rowasa) have fewer side effects than sulfa-containing Azulfidine. In UC patients with moderate to severe disease and in patients who failed to respond to 5-ASA compounds, systemic (oral) corticosteroids should be used. Systemic corticosteroids (prednisone, prednisolone, cortisone, etc.) are potent and fast-acting drugs for treating UC, Crohn's ileitis and ileocolitis. Systemic corticosteroids are not effective in maintaining remission in patients with UC. Serious side effects can result from prolonged corticosteroid treatment. To minimize side effects, corticosteroids should be gradually reduced as soon as the disease remission is achieved. In patients with corticosteroid-dependent or unresponsive to corticosteroid treatment, surgery or immunomodulator is considered. Immunomodulators used for treating severe UC include azathioprine/6-MP, methotrexate, and cyclosporine. Integrated traditional Chinese and Western medicine is safe and effective in maintaining remission in patients with UC.Xu CT, Meng SY, Pan BR. Drug therapy for ulcerative colitis.

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Further validation of high-magnification chromoscopic-colonoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis

Cited by 128 publications

References 12 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Magnifying chromoscopy, a novel and useful technique for colonoscopy in ulcerative colitis

Drug therapy for ulcerative colitis

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