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December 6, 1976

ColonoscopyInefficacy for Early Carcinoma Detection in Patients With Ulcerative Colitis

Author Affiliations

From the sections of gastroenterology (Drs Crowson and Ferrante) and colon and rectal surgery (Dr Gathright), Ochsner Medical Institutions, New Orleans.

JAMA. 1976;236(23):2651-2652. doi:10.1001/jama.1976.03270240047027

CANCER of the large intestine frequently develops in patients who have had ulcerative colitis for more than ten years. When ulcerative colitis begins in childhood and involves the entire colon, the incidence of colonic cancer after the first ten years is reported to be 20% per decade. With the advent of colonoscopy, it is now suggested that multiple, periodic, colonoscopic biopsies with tissue taken from throughout the colon can detect the early development of cancer1,2 in patients with chronic ulcerative colitis. The following case report shows that colonoscopy, even in the hands of an excellent endoscopist, cannot always be relied on in the diagnosis of carcinoma.

Report of a Case  A 34-year-old man was first seen at the Ochsner Clinic in 1972. In 1963 a chronic diarrhea that he had had since 1962 had been diagnosed elsewhere as ulcerative colitis. The colitis had been well controlled with salicylazosulfapyridine (Azulfidine);