The Dilemmas

The current standard of practice in all patients with extensive UC of 8 or more years of duration is to perform lifelong colonoscopic biopsy surveillance. Yet, the optimal protocol for this surveillance has not been established. The lack of consensus on which patients warrant frequent colonoscopy is compounded by the divergent opinions regarding what constitutes adequate colonoscopic surveillance. A major problem in surveillance is the large surface area of the colon, which ranges from 0.5 to 1.0 m2. Dysplasia may arise anywhere within this large area and frequently produces no endoscopically visible lesion.

is based on a scientific data analysis (Winawer et al, 1997). Our prospective studies have shown that to detect focal dysplasia in UC with 90% confidence, 33 colonoscopic biopsies must be examined histologically (Rubin et al, 1999). The acquisition of this many biopsies is both time and cost intensive, however once the patient's histologic diagnosis is established with confidence, it may be possible to extend the surveillance intervals.

Our current protocol is to obtain biopsies at 4 quadrants every 10 cm from the cecum through the descending

UC patient with pancolitis 8 years or left-sided colitis >15 years

Annual to biannual colonoscopy with biopsies at 10-12 cm intervals

UC patient with a 8 years duration or

PSC patient at diagnosis of UC

Surveillance colonoscopy with biopsies at 4 quadrants q 10 cm

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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