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Colonoscopic surveillance in inflammatory bowel disease.

Purpose Of Review: To describe recent findings in the literature aimed at decreasing systematic error in dysplasia surveillance in inflammatory bowel disease.Recent Findings: Despite great promise, colonoscopic surveillance in inflammatory bowel disease has yet to be demonstrated to reduce colorecta...

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Published in:Current Opinion in Gastroenterology Vol. 21; no. 5; pp. 585 - 589
Main Author: Ullman, Thomas A
Format: research Journal Article
Published: Lippincott Williams & Wilkins Sep2005
Online Access:View this record in EBSCOhost
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      dt: Sep2005
      vid: 21
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      pub: Lippincott Williams & Wilkins
      place: Baltimore, Maryland
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        atl: Colonoscopic surveillance in inflammatory bowel disease.
      aug:
        au: Ullman, Thomas A
        affil: Mount Sinai School of Medicine, New York, New York 10029, USA
      sug:
        subj:
          Colonoscopy Methods
          Inflammatory Bowel Diseases Diagnosis
          Human
          Diagnosis, Differential
          Reproducibility of Results
      ab: Purpose Of Review: To describe recent findings in the literature aimed at decreasing systematic error in dysplasia surveillance in inflammatory bowel disease.Recent Findings: Despite great promise, colonoscopic surveillance in inflammatory bowel disease has yet to be demonstrated to reduce colorectal cancer mortality. In part, this stems from a number of inherent systematic troubles, including low rates of observer agreement among pathologists; lack of consensus on the natural history of dysplasia, particularly low-grade dysplasia; the patchy nature of dysplasia, which leads to sampling error caused by insufficient biopsy by endoscopists; and incomplete patient follow-up. Recent publications that have focused on defining better the natural history of different levels of dysplasia and improving dysplasia identification at the time of colonoscopy may aid in overcoming the flaws of surveillance. The key recent findings include conflicting evidence on the relative danger of flat low-grade dysplasia, the safety of treating polypoid low-grade dysplasia as a benign adenoma in the absence of flat dysplasia in the rest of the colon or the surrounding mucosa, and preliminary support of chromoendoscopy to target dysplasia better during colonoscopy and to limit unnecessary nontargeted biopsies.Summary: These and other advances stand a reasonable chance of making surveillance a more accurate tool to discriminate between patients with chronic colitis likely to progress to advanced pathology and those less likely to do so. Such advances may result in effective surveillance in which both colorectal cancer mortality and unnecessary colectomy may be limited.
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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