Colitis cystica profunda: a systematic review.
Thomas Stirrat, Deeptha Bejugam, Joseph Alukal et al.
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In 30 seconds
This PRISMA 2020 systematic review synthesized 65 studies of histologically confirmed colitis cystica profunda (CCP), comprising 92 patients, to describe presentation, diagnosis, management, and outcomes. Rectal bleeding was the most common symptom (70%), and lesions were usually distal. Superficial biopsies reached the submucosa in only 32%, contributing to sampling error. Surgery was used in 67% of patients; dysplasia and coexisting invasive adenocarcinoma were reported in 10% and 4%, respectively. No subsequent malignant transformation was reported over a median follow-up of 8.4 months.
Key findings
- Rectal bleeding was reported in 70% of patients; 61% of lesions were rectal.
- Superficial biopsies reached the submucosa in only 32%, contributing to frequent sampling error.
- Surgery was performed in 67% of patients; postoperative morbidity occurred in 5% and recurrence in 4%.
- Dysplasia was reported in 10% and coexisting invasive adenocarcinoma in 4%; no subsequent malignant transformation was reported over a median follow-up of 8.4 months.
Why it matters
CCP can resemble colorectal malignancy, while superficial sampling may fail to establish the diagnosis. The review highlights the value of obtaining deeper tissue and using high-resolution imaging to characterize submucosal lesions. Its reported outcomes also underscore the importance of distinguishing CCP from cancer when considering the extent of intervention.
What to keep in mind
The evidence came from case reports and series, and median follow-up was 8.4 months; the findings therefore provide limited evidence about longer-term outcomes.