Issue 10

Clinical Question

What is the risk of colorectal cancer (CRC) among patients with colitis and consecutive negative colonoscopies?

Editor’s Bottom Line

The risk of colorectal neoplasia varies among IBD patients, and these data support individualized surveillance strategies that consider previous endoscopic findings.

Reference

ten Hove JR, Shah SC, Shaffer SR, et al. Consecutive negative findings on colonoscopy during surveillance predict a low risk of advanced neoplasia in patients with inflammatory bowel disease with long-standing colitis: results of a 15-year multicentre, multinational cohort study. Gut. 2019; 68(4):615–22; http://dx.doi.org/10.1136/gutjnl-2017-315440

Synopsis

In this multicentre study, investigators retrospectively examined data from 775 IBD patients with colitis for at least eight years who were undergoing CRC surveillance colonoscopies between 2000 and 2015. Patients were followed for three colonoscopies during this period.

Researchers compared rates of advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia or CRC, occurring between surveillance colonoscopies among those with negative versus positive colonoscopies. Colonoscopies were considered negative if no post-inflammatory polyps, strictures, endoscopic disease activity or evidence of neoplasia was found, while colonoscopies with any of these features were considered positive. Over 60% of patients had ulcerative colitis, roughly half were female and patients were a median 44 years of age at study entry. The mean duration of follow-up after the first colonoscopy was 6.1 years. Chromoendoscopy was used in some but not all cases.

Findings showed that among the 44% of subjects with a negative first colonoscopy, 0.3% subsequently had evidence of aCRN at their second colonoscopy. In contrast, 2.8% of those with a positive first colonoscopy had evidence of aCRN at their second colonoscopy. Second colonoscopies were conducted a median 2.2 years after the first in both groups. None of those who had two consecutive negative colonoscopies developed aCRN by their third colonoscopy, compared to an incidence of 0.29–0.76 cases per 100 patient years among those who had at least one positive colonoscopy (P=0.02).

An analysis of 587 patients with one or more risk factors for aCRN—including primary sclerosing cholangitis, a history of dysplasia or a stricture, or a first-degree relative with CRC—found the association between colonoscopy outcomes and subsequent aCRN risk remained significant.

Details

Study Design: Retrospective cohort
Funding: No external funding.
Allocation: Not applicable
Setting: Multinational databases
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.