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要旨 当院における潰瘍性大腸炎に対するsurveilianceの実態を調査するとともに,発見されたcolitic cancer,dysplasia症例を検討した.1997年4月時点でsurveillanceの対象となった長期経過例は114例で,その後の5年間に毎年surveillance colonoscopyを受けていたのは79%のみであり,全患者の平均surveillance colonoscopy回数は1.9回/5年にすぎず,random生検を施行している症例も一部のみであった.しかし,この期間中に発見されたcolitic cancerの予後はおおむね良好であり,欧米の報告に比べて早期癌で発見された症例が多かった.また,報告例を見る限り欧米で行われている1年ごとのrandom生検によるsurveillanceは,物理的にも対費用効果の問題からも実効性は少ないと思われた.今後,長期経過例におけるsurveillanceへの意識を高め,検査に対するcomplianceを維持するとともに,内視鏡観察の精度向上と分子生物学的手法を用いた効率の良いsurveillance法の確立が望まれる.
Colorectal cancer is a major cause of an increased mortality rate in patients with longstanding ulcerative colitis (UC) . There is now general, albeit not universal, agreement that this association exists, but the magnitude of the increase in risk is a point of considerable debate. Furthermore, while surveillance colonosocpy (SCS) has been widely performed to survey colitic cancers, vigorous debate and clinical uncertainty surround the issue of whether colitic cancer can be prevented by SCS. Here we analyzed the data of 114 patients enrolled in our SCS program from 1997 to 2002. By precise endoscopic observation, target biopsies against macroscopic lesions have been performed in our SCS, while random biopsies are commonly accepted in the Western countries. Six cases of carcinoma and/or high-grade dysplasia were discovered among those patients. The prognosis of colitic cancers discovered in our SCS program was comparatively favorable. It was only 7.9% of the patients that had received SCS once per year, and the average number of times of SCS in five years was 1.9 times per patient. Indeed, it seems to be important to maintain compliance of long-standing UC patients for SCS. At present, although biannual SCS with target biopsy is thought to be an adequate method for decreasing mortality in UC, the improvement in accuracy of endoscopic observation and establishment of more efficient surveillance strategy using the molecular biological technique are desired.
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