P397 Surveillance in ulcerative colitis: Can we predict the risk for intraepithelial neoplasia?

Abstract Background Ulcerative colitis (UC) has been associated with an increased risk of colorectal cancer (CRC). Although dye spray chromoendoscopy showed superiority to standard colonoscopy in surveillance studies, with the availability of higher-resolution colonoscopes, the utility of chromoendoscopy (CE) has been questioned. We aimed to evaluate the risk of intraepithelial neoplasia (IN) after a high-quality screening colonoscopy (making use of CE or random biopsies (RB) and removing all detected lesions) in a population with longstanding UC and to identify potential risk factors for dysplasia incidence. Methods In a previous study, 145 patients with clinically and endoscopic longstanding (≥8 yr) distal/extensive UC without primary sclerosing cholangitis and/or history of IN were prospectively randomised to undergo CE or RB. In this study, after a median follow-up of 5 additional years, we evaluated subsequent IN incidence in these patients, submitted to surveillance colonoscopy. Patients without high-quality surveillance colonoscopy (with good bowel preparation and cecum intubation) using high-definition were excluded. Results One hundred and twenty-one patients were included. Nine had removed adenomas with low-grade dysplasia in the index colonoscopy. Now, in surveillance colonoscopy, we detected 9 (7.4%) IN: low-grade dysplasia was found in 8 (6.6%) patients and a colorectal adenocarcinoma in 1 (0.008%) patient. After multivariate analysis, IN was significantly associated with older age (68 vs. 52 years, p < 0.05) and higher disease duration (26 vs. 20 years, p < 0.05). No association was found between IN and previous detection of IN in screening colonoscopy sex, the CE or RB use in index colonoscopy, extent of disease, The presence of pseudopolyps, smoking habits, familial history of CRC or maintenance therapy for UC. Conclusion In this study, older patients and higher disease duration were associated with a higher risk of IN in surveillance colonoscopy.

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Motion - Colonoscopic Surveillance is More Cost Effective than Colectomy in Patients with Ulcerative Colitis: Arguments for the Motion

Canadian Journal of Gastroenterology ◽

10.1155/2003/759457 ◽

2003 ◽

Vol 17 (2) ◽

pp. 119-121 ◽

Cited By ~ 1

Author(s):

Bret A Lashner

Keyword(s):

Ulcerative Colitis ◽

Cost Effective ◽

Low Grade ◽

Surveillance Colonoscopy ◽

Case Control Studies ◽

Colonoscopic Surveillance ◽

Prophylactic Colectomy ◽

Increased Risk ◽

Surveillance Programs ◽

Related Mortality

Patients with ulcerative colitis (UC) are at increased risk for colorectal cancer (CRC), especially those with longstanding disease, pancolitis or primary sclerosing cholangitis. The incidence of colitis- associated cancer is increasing, and the mortality rates from CRC are higher in UC patients than in the general population. Case control studies have demonstrated that surveillance colonoscopy reduces the risk of dying from CRC. A well conducted decision analysis found that surveillance colonoscopy decreases cancer-related mortality and increases life expectancy. The results with surveillance programs were almost as good as with prophylactic colectomy. A subsequent cost effectiveness analysis using the same model found that, compared with a policy of no surveillance, colonoscopic surveillance was more effective at preventing death from CRC and was less costly. The best strategy appears to be to perform colonoscopies every three years. The analysis also showed that colectomy should be recommended in patients with low-grade dysplasia. Patients at very high risk for CRC should undergo yearly colonoscopy, and patients who are concerned about the limitations of this technique should be offered prophylactic colectomy.

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Natural history of low grade dysplasia in patients with primary sclerosing cholangitis and ulcerative colitis

Journal of Crohn s and Colitis ◽

10.1016/j.crohns.2013.02.002 ◽

2013 ◽

Vol 7 (12) ◽

pp. 968-973 ◽

Cited By ~ 28

Author(s):

Preethi G.K. Venkatesh ◽

Ramprasad Jegadeesan ◽

Norma G. Gutierrez ◽

Madhusudhan R. Sanaka ◽

Udayakumar Navaneethan

Keyword(s):

Ulcerative Colitis ◽

Natural History ◽

Primary Sclerosing Cholangitis ◽

Sclerosing Cholangitis ◽

Low Grade ◽

History Of ◽

Low Grade Dysplasia

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Editorial: Clarity and Caution in the Natural History of Low-Grade Dysplasia in Ulcerative Colitis

The American Journal of Gastroenterology ◽

10.1038/ajg.2015.315 ◽

2015 ◽

Vol 110 (10) ◽

pp. 1473-1474

Author(s):

John B Kisiel ◽

Edward V Loftus

Keyword(s):

Ulcerative Colitis ◽

Natural History ◽

Low Grade ◽

History Of ◽

Low Grade Dysplasia

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Risk of Colorectal Cancer in Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2019/5363261 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

Qing Zhou ◽

Zhao-Feng Shen ◽

Ben-sheng Wu ◽

Cheng-biao Xu ◽

Zhong-qi He ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Ulcerative Colitis ◽

English Language ◽

Disease Duration ◽

Meta Analysis ◽

Disease Extent ◽

Increased Risk ◽

History Of ◽

Scientific Meetings

Background. Ulcerative colitis (UC) patients have an increased risk for the development of colorectal cancer (CRC). Our aim was to assess the risk of CRC in UC patients compared with disease extent, disease duration, and geographic variation. Methods. In this systematic review and meta-analysis, we searched PubMed, scientific meetings, and the bibliographies of identified articles, with English language restrictions for studies published from 1988 to 2018, and assessed the risk of CRC in UC patients. Patients with Crohn’s disease, family history of CRC, and colorectal adenomatous polyp (CAP) were excluded from this research. The study was registered with PROSPERO, number CRD42018102213. Findings. We included 58 studies that included 267566 UC patients. Extensive UC and left-sided UC had a higher risk of CRC than proctitis UC. Geography also played a role in UC-associated CRC development. The time of malignant transformation in Asian UC patients started after 10-20 years of this disease duration. North American UC-associated CRC patients significantly increased in more than 30 years of this disease duration. Conclusion. In a systematic review of the literature, we found that disease extent, disease duration, and geography were strong, independent risk factors in UC-associated CRC development.

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Risk of colorectal adenomas and cancer in monoallelic carriers of MUTYH pathogenic variants: a single-centre experience

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03983-x ◽

2021 ◽

Author(s):

R. Patel ◽

P. McGinty ◽

V. Cuthill ◽

M. Hawkins ◽

S. K. Clark ◽

...

Keyword(s):

Colorectal Adenomas ◽

Screening Colonoscopy ◽

Low Grade ◽

Surveillance Colonoscopy ◽

Pathogenic Variants ◽

Adenoma Detection ◽

Increased Risk ◽

Single Centre Experience ◽

Current Guidance

Abstract Purpose The carrier frequency of MUTYH pathogenic variants in the population may be as high as one in 45. Some studies have found an increased risk of colorectal cancer (CRC) in monoallelic carriers of MUTYH pathogenic variants, but the role of early surveillance colonoscopy is not conclusive. This study aimed to assess the outcomes of colonoscopy surveillance in MUTYH carriers. Methods Patients, with a monoallelic pathogenic variant in MUTYH, found at cascade testing, were identified from the St Mark’s Hospital Polyposis Registry database. Findings at surveillance colonoscopy were reviewed. Results Two hundred and forty-nine carriers were identified, of whom 125 had undergone at least one surveillance colonoscopy. Twenty-eight patients (22%) developed at least one adenoma; all adenomas had low-grade dysplasia (LGD). The median age at first colonoscopy was 36 years (range 16–75 years). The median age at first adenoma detection was 43 years (range 22–75 years). The cumulative incidence of adenoma development by age 30, 40, 50, 60 and 70 years was 3.2%, 8.8%, 15.2%, 18.4% and 20.8%, respectively. No CRCs were observed. Conclusions Our cohort of monoallelic carriers of MUTYH pathogenic variants is a relatively younger group than adults entering population screening colonoscopy, but a high adenoma rate was not observed. No CRCs were detected, suggesting that current guidance that these individuals should be managed in the same way as the general population is reasonable.

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Dysplastic Progression to Adenocarcinoma is Equivalent in Ulcerative Colitis and Crohn’s Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa133 ◽

2020 ◽

Author(s):

Amy L Lightner ◽

Sarah Vogler ◽

John McMichael ◽

Xue Jia ◽

Miguel Regueiro ◽

...

Keyword(s):

Ulcerative Colitis ◽

Low Grade ◽

High Grade ◽

Surveillance Colonoscopy ◽

Right Colon ◽

Significant Difference ◽

Rate Of Progression ◽

Low Grade Dysplasia ◽

The Right ◽

Crohn’S Diseases

Abstract Background We sought to determine the rate of progression from dysplasia to adenocarcinoma in ulcerative colitis [UC] vs Crohn’s diseases [CD] and describe the risk factors unique to each. Methods All adult patients [≥18 years] with a known diagnosis of either UC or CD who underwent a surveillance colonoscopy between January 1, 2010 and January 1, 2020 were included. Results A total of 23 751 surveillance colonoscopies were performed among 12 289 patients between January 1, 2010 and January 1, 2020; 6909 [56.2%] had a diagnosis of CD and 5380 [43.8%] had a diagnosis of UC. There were a total of 668 patients [5.4%] with low-grade dysplasia [LGD], 76 patients [0.62%] with high-grade dysplasia [HGD], and 68 patients [0.55%] with adenocarcinoma in the series; the majority of the dysplastic events were located in the right colon. Significantly more UC patients had a dysplastic event, but the rate of LGD and HGD dysplasia progression to adenocarcinoma was not significantly different in CD or UC [p = 0.682 and p = 1.0, respectively]. There was no significant difference in the rate of progression from LGD/HGD to adenocarcinoma based on random biopsies vs targeted biopsies of visible lesions [p = 0.37]. However, the rate of progression from LGD vs HGD to adenocarcinoma was significantly greater for HGD [p < 0.001]. Conclusion While more UC patients were found to have neoplasia on colonoscopy, the rate of progression from LGD and HGD to adenocarcinoma was equivalent in UC and CD, suggesting that endoscopic surveillance strategies can remain consistent for all IBD patients.

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Adherence to Recommendations and Quality of Endoscopic Colorectal Cancer Surveillance in Long-Standing Ulcerative Colitis

Inflammatory Intestinal Diseases ◽

10.1159/000511010 ◽

2020 ◽

pp. 1-7

Author(s):

Giulia Santi ◽

Pierre Michetti ◽

Florian Froehlich ◽

Jean-Benoît Rossel ◽

Valérie Pittet ◽

...

Keyword(s):

Colorectal Cancer ◽

Ulcerative Colitis ◽

Bowel Preparation ◽

Disease Duration ◽

Screening Colonoscopy ◽

Withdrawal Time ◽

Crc Screening ◽

Number Of Patients ◽

Increased Risk

Background: Long-standing ulcerative colitis has been associated with an increased risk of colorectal cancer (CRC). Current guidelines recommend endoscopic CRC screening after 8 years of disease duration. The objectives of our study were to assess the adherence to recommendations and the quality of endoscopic procedure in long-standing ulcerative colitis. Methods: This is a retrospective cohort study. We selected patients included in the Swiss IBD cohort with a disease duration of ≥8 years and an extension above the rectosigmoid junction. The complementary medical chart review focused on endoscopy and associated histological reports in 8 Swiss centers. Descriptive analyses focused on patients and their colonoscopies. Results: 309 colonoscopies were conducted among 116 patients with the following characteristics: women 47%, mean age at diagnosis 31 years, and pancolitis disease extent in 65.5% of cases; 38.8% of patients had a first screening colonoscopy <8 years, 13.8% between 8 and 10 years, and 47.4% >10 years. Cecal intubation was performed in 94.5% of cases, and bowel preparation was good to excellent in 61.5% of endoscopies. Chromoendoscopy was used in 7.4% of cases, and the mean withdrawal time was 16.4 min. Dysplasia was found in 6.2% of cases. Conclusion: Despite current international recommendations, a significant number of patients did not receive a proper endoscopic surveillance. An increased use of chromoendoscopy, monitoring of withdrawal time, and appropriate bowel preparation would increase the quality of CRC screening. The adherence to screening guidelines and endoscopic quality should be promoted and standardized.

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