Abstract
Background
Background: Patients with Crohn’s disease (CD) and ulcerative colitis (UC) are at increased risk for colorectal dysplasia (CRD) and cancer (CRC). Adherence to CRC surveillance guidelines is reportedly low internationally.
Aims
Aims: To evaluate surveillance practices at the tertiary IBD Center of the McGill University Health Center (MUHC) and to determine CRD/CRC incidence.
Methods
Methods: A representative IBD cohort with at least 8 years of disease duration (or with PSC) who visited the MUHC between July 1st -December 31st , 2016 were included. Adherence to surveillance guidelines was compared to modified 2010 BSG guidelines. Incidence of CRC, high-grade dysplasia (HGD), low-grade dysplasia (LGD) and colorectal adenomas (CRA) were calculated based on pathology reports.
Results
Results: 1356 CD and UC patients (disease duration: 12 (IQR:6–22) and 10 (IQR: 5–19) years) were identified. The surveillance cohort consisted of 680 patients (296 UC and 384 CD). Adherence to surveillance guidelines was 75.6/82.1% in UC/colonic CD. Adequate number of biopsies were taken in 53.7/54.2% of UC/colonic CD patients. Incidence of CRC/HGD in UC and CD with colonic involvement was 19.5/58.5 and 25.1/37.6 per 100,000 patient-years, respectively. Incidence of dysplasia before 8 years of disease duration was low in both UC/CD (19.5 and 12.5/100,000 patient-years) with no CRC detected. The CRA rate was 30/38% in UC/colonic CD.
Conclusions
Conclusion: High adherence to surveillance guidelines and low CRC and dysplasia, but not CRA rates were found, suggesting that adhering to updated, stratified, surveillance recommendations may result in low advanced neoplasia rates. The incidence of dysplasia before the start of surveillance was low.
Incidence of Dysplasia in the Surveillance Cohort
| Type of Dysplasia | CD L2-L3 (n/100,000 patient-years) | UC (n/100,000 patient-years) | PSC (n/100,000 patient-years) |
|---|---|---|---|
| CRC | 25.1 | 19.5 | 0 |
| HGD | 37.6 | 58.5 | 0 |
| LGD | 125.5 | 351.1 | 702.5 |
| Any dysplasia | 150.6 | 370.6 | 936.7 |
| Tubular adenoma | 1230 | 1736.2 | 2576.1 |
| Dysplasia prior to 8 years | 12.5 | 19.5 | 0 |
| CRC prior to 8 years | 0 | 0 | 0 |
Funding Agencies
None