Colorectal cancer surveillance in patients with ulcerative colitis

Background and Aims: Ulcerative colitis increases the risk of developing colorectal cancer. Colonoscopic surveillance is recommended although there are no randomized trials evaluating the efficacy of such a strategy. This study is an update of earlier studies from an ongoing colonoscopic surveillance program. Material and Methods: All patients with ulcerative colitis were invited to the surveillance program that started in 1977 at Örnsköldsvik Hospital, located in the northern part of Sweden. Five principal endoscopists performed the colonoscopies and harvested mucosal sampling for histopathological evaluation. Some 323 patients from the defined catchment area were studied from 1977 to 2014. At the end of the study period, 130 patients, including those operated on, had had total colitis for more than 10 years. Results: In total, 1481 colonoscopies were performed on 323 patients during the study period without any major complications. In all, 10 cases of colorectal cancer were diagnosed in 9 patients, of whom 1 died from colorectal cancer. The cumulative incidence of colorectal cancer was 1.4% at 10 years, 2.0% at 20 years, 3.0% at 30 years, and 9.4% at 40 years of disease duration, respectively. The standardized colorectal cancer incidence ratio was 3.01 (95% confidence interval: 1.42–5.91). Major surgery was performed on 65 patients; for 20 of these, the indication for surgery was dysplasia or colorectal cancer. Panproctocolectomy was performed in 43 patients. Conclusion: This study supports that colonoscopic surveillance is a safe and effective long-term measure to detect dysplasia and progression to cancer. The low numbers of colorectal cancer-related deaths in our study suggest that early detection of neoplasia and adequate surgical intervention within a surveillance program may reduce colorectal cancer mortality in ulcerative colitis patients.

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P128 Colorectal cancer surveillance with chromoendoscopy in inflammatory bowel disease: results from a real life experience

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.257 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S201-S201

Author(s):

C Rubín De Célix Vargas ◽

M Chaparro ◽

J A Moreno ◽

C Santander ◽

J P Gisbert

Keyword(s):

Colorectal Cancer ◽

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Endoscopic Resection ◽

Bowel Disease ◽

Detection Rate ◽

Real Life ◽

Cancer Surveillance ◽

Inflammatory Bowel ◽

Colorectal Cancer Surveillance

Abstract Background Patients with inflammatory bowel disease (IBD) are at increased risk for developing colorectal cancer (CRC). Recent practice guidelines suggest the use of chromoendoscopy with targeted biopsies to identify dysplastic lesions. The aim of this study was to know the dysplasia detection rate with chromoendoscopy in a real life cohort and to describe endoscopic characteristics of the lesions detected and their management. Methods Single-centre retrospective and observational study of all chromoendoscopies done between January 2016 and May 2019 in adult patients with left-sided/extensive ulcerative colitis or Crohn’s disease involving more than one-third of the colon. All polyp characteristics were collected (localisation, size, Paris and Kudo classifications) and their treatments received (endoscopic resection or surgery). Results One hundred and eighty-six chromoendoscopies on 160 patients were included. Of all chromoendoscopies, the dysplasia detection rate was 24% (23% of patients had dysplasia in any chromoendoscopy done during the period of the study). Ninety-two patients (57%) were men. Eighty-six (54%) had ulcerative colitis, 72 (45%) Crohn’s disease and 2 (1%) non-classifiable IBD. Twenty-five (15%) had family history of CRC. 118 (74%) received treatment with aminosalicylates, 67 (42%) with thiopurines and 42 (26%) with biologics. A total of 212 lesions were detected, 94% were located in areas of mucosa close to the segment affected by IBD. Most of them were located in the rectum (36%) and left colon (30%). More than half of the lesions were flat polyps (31% Paris 0-IIa, 25% Paris 0-IIb). The most frequent Kudo pit pattern was Kudo II (43%) and Kudo IIIs (33%). A total of 123 (58 %) lesions were non-neoplastic and 74 (35%) were neoplastic. Among these, 69 (93%) were low-grade dysplasia and five were high-grade dysplasia: 5/5 located in rectum, and one of them could not be suitable for endoscopic resection. Twelve lesions could not be retrieved. Only five patients (3%) required surgical treatment. In the univariate analysis, the presence of dysplasia was not related with age, sex, smoking, or type of IBD. Dysplastic lesions were more frequently localised distal to the splenic flexure (OR, 0.543; 95% CI, 0.30–0.99; p < 0.05) compared with non-dysplastic lesions; they were non-polypoid lesions: Paris 0-IIa, 0-IIb, 0-IIc (OR, 0.11; 95% CI, 0.02–0.59; p < 0.001). The polyp size was not a predictor of dysplasia. Conclusion This study reports a high dysplasia detection rate (24%) via targeted chromoendoscopic biopsies in a real life cohort. Endoscopic resection removed the lesions in most of the cases; only 3% of patients need surgery (partial colectomy). Our results underlines the importance of colorectal cancer surveillance in IBD patients.

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