Accuracy and acceptability of surveillance tests after total colectomy and ileorectal anastomosis

Abstract

BACKGROUND AND AIMS: Surveillance of the rectal stump after total colectomy for familial adenomatous polyposis (FAP) or chronic ulcerative colitis (CUC) is empirically based on periodic outpatient visit with digital exploration and proctoscopy. Exfoliative cytology is supported as a complementary tool of investigation. The aim of present study is to compare accuracy and acceptability of the above mentioned tests.

PATIENTS AND METHODS: Forty patients who underwent total colectomy were prospectively enrolled, including 12 FAP patients, 16 CUC patients, 12 patients with slow-transit constipation. Each patient underwent digital exploration of the rectum, proctoscopy with eventual biopsy and rectal lavage with exfoliative cytology. Diagnostic accuracy rates were calculated for the dysplastic/polypoid and inflammatory findings. A structured questionnaire was used in order to evaluate patient acceptability of each test.

RESULTS: Sensitivity and specificity for inflammatory lesions was higher using proctoscopy and biopsy (100% and 100%, respectively) than using exfoliative cytology (87% and 92%, respectively) or digital exploration (87% and 88%, respectively). Sensitivity and specificity for dysplastic/polypoid lesions was higher using proctoscopy and biopsy (91% and 100%, respectively) than using exfoliative cytology (50% and 83%, respectively) or digital exploration (50% and 97%, respectively).

Mean acceptability score of proctoscopy (3.29) was substantially lower than those of digital exploration (4.29), and of exfoliative cytology (4.38). Only 2.5% of patients preferred proctoscopy on alternative tests.

CONCLUSIONS: At present, proctoscopy with biopsy remains the most accurate test for surveillance of the rectal stump, however a significant proportions of patients consider it scarcely acceptable. A negative impact on surveillance protocol compliance is consecutively anticipated.