Prospective surveillance by rectal biopsy following ileorectal anastomosis for inflammatory disease

Abstract

A prospective study was designed to evaluate multiple rectal biopsy examinations for dysplasia in 34 patients who had ileorectal anastomosis performed, following colectomy for inflammatory bowel disease. Although all but eight patients had persistent inflammatory activity on histologic examination, only one patient who demonstrated villous transformation of the mucosa clinically, showed carcinoma in situ in the excised rectal specimen. A protocol for surveillance of preserved rectums in inflammatory bowel disease is offered.

Ileorectal Anastomosis for Ulcerative Colitis: Prevention of Relapses and Neoplasia of the Rectal Stump with Topical Treatment

“…Another reason for the success of medical treatment is the prevention of dyspla sia, and its regression after 3-5 years of treatment. After a 15-year follow-up period, a 60% rate of dysplasia is expected [26], In our series, not only did dysplasia not develop, but the 2 patients with dysplasia showed regres sion of the lesions. This is not the only report of revers ibility of dysplasia; Khubchandani et al [26] observed a case of high-grade dysplasia that reverted to mild-grade dysplasia, and Johnson et al [27] found that 52.9% of the patients with moderate dysplasia shortly after the opera tion reverted to mild dysplasia or to normal 15 years later.…”

Ileorectal Anastomosis in Ulcerative Colitis

“…According to the literature the inci dence of rectal carcinoma is nil for the first 10 years of symptom duration, it slowly increases from 10 to 20 years and seems to be about 15 % after 30 years, but there are very few patients at risk in any series at that time. As proposed and illustrated by Morson and Pang [9] and others [5] it may be possible to anticipate the develop ment of rectal cancer by regular multiple biopsies. Sec ondary proctectomy must then be discussed as a prophy lactic procedure when severe dysplasia is found in the rectal stump.…”

A prospective study of dysplasia and carcinoma in the rectal biopsies and rectal stump of eight patients following ileorectal anastomosis in ulcerative colitis

“…Group A fits with the general experience that patients in whom severe dysplasia is detected have a high chance of carcinoma being found elsewhere in the rectum (or colon) (Morson & Pang 1967, Lennard-Jones etal. 1977, Khubchandani et al 1982, Sherlock 1983 1983), and that the probability of developing carcinoma following the diagnosis of moderate/or severe dysplasia can be as high as 42% at 9 years from the initial histological diagnosis (Johnson et al 1983b). Thus, in view of the good prognosis associated with a Duke's A carcinoma, early proctectomy may be indicated in this group of patients.…”

“…Since the original paper of Morson & Pang in 1967, dysplasia is at present the most reliable marker of a precancerous state in ulcerative colitis. Therefore, a rigid follow-up regime of these patients should minimize the development of invasive carcinoma (Khubchandani et al 1982, Johnson et al 1983b, Lennard-Jones et al 1983), However, true as the theory might be, we still fail in practice to detect early cancer in some patients. The problems arise from: (i) the patchy focal nature of dysplasia; (ii) its possible absence in the presence of carcinoma (Evans & Pollock 1972, Lennard-Jones et al 1977; (iii) the little known natural history of dysplasia; (iv) the failure of endoscopy to detect the presence of dysplasia in flat mucosa (Riddell 1980, Waye 1983and (v) the difficulties in distinguishing between true dysplasia and cellular atypia due to inflammation.…”