Tsuyoshi Fujimoto

Risk Factors and Indications for Colectomy in Ulcerative Colitis Patients are Different According to Patient’s Clinical Background

PurposeDespite progress in medical treatment for ulcerative colitis, a considerable fraction of ulcerative colitis patients undergo colectomy. We analyzed the clinical variables of ulcerative colitis patients and determined the risk factors and indications for colectomy.MethodsThe clinical records of 981 consecutive Japanese patients with ulcerative colitis were reviewed both retrospectively and prospectively.ResultsOf 981 patients with ulcerative colitis, 85 patients underwent colectomy. Multivariate analysis indicated that male gender (risk ratio, 2.16; 95 percent confidence interval, 1.37–3.42), onset year during and after 2000 (risk ratio, 2.85; 95 percent confidence interval, 1.31–6.22), severe disease activity (risk ratio, 2; 95 percent confidence interval, 1.15–3.48), corticosteroid resistance (risk ratio, 7.05; 95 percent confidence interval, 4.29–11.59), and complications because of corticosteroid administration (risk ratio, 3.55; 95 percent confidence interval, 2.08–6.06) were significant risk factors for colectomy. In patients with disease duration of more than five years, only corticosteroid resistance and complications because of corticosteroid were significant risk factors for colectomy. When we stratified indications for colectomy for the 85 cases via patient disease duration, massive hemorrhage was a relatively frequent cause of colectomy in patients with a disease duration of less than five years (P = 0.091). On the other hand, colon dysplasia or cancer was a major cause for colectomy in patients with a disease duration of more than ten years (P = 0.0001).ConclusionsIn ulcerative colitis patients, the risk factors and indications for colectomy were different according to the patients clinical background. Our findings may help to predict patients with ulcerative colitis who have a high risk for colectomy.

Risk factors for high-grade dysplasia or carcinoma in colorectal adenoma cases treated with endoscopic polypectomy

Objective Our aim is to establish the risk factors for carrying high-grade dysplasia or carcinoma by analyzing endoscopically treated adenoma cases. Methods Patients who underwent endoscopic polypectomy at our hospitals between January 2003 and August 2004 were analyzed. Results A total of 889 patients (mean age: 63±11 years), and 1486 adenomas resected from these patients, were included in the analysis. Seventy-five adenomas (5%) from 72 patients (8%) were found to have high-grade dysplasia or carcinoma. Among patient factors, female sex [odds ratio (OR) 2.25, 95% confidence intervals (CI)=1.34–3.76], presence of multiple adenomas (OR=2.15, 95% CI=1.15–4.00), older age (OR=1.02, 95% CI=1.00–1.04), and rectal bleeding as the indication for colonoscopy (OR=2.57, 95% CI=1.34–4.92) were identified as the significant risk factors for carrying high-grade dysplasia or carcinoma using the multivariate analysis. In addition, a size of ≥10 mm (OR=10.83, 95% CI=5.86–20.0), flat appearance (OR=3.91, 95% CI=2.20–6.95), and location on the left side of the colon (OR=1.80, 95% CI=1.03–3.13) were identified as tumor risk factors. Conclusion Distinct factors were proved to be associated with high-grade dysplasia or carcinoma. These results are useful to select lesions that require immediate treatment. Moreover, female sex as a risk factor raises an interesting problem regarding the progression from adenoma to carcinoma.