IBD: guideline-based cancer surveillance works

  • Singh K & al.
  • J Crohns Colitis
  • 28 mar. 2019

  • de Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • This single-center study of patients with longstanding Crohn’s disease (CD) and ulcerative colitis (UC) linked guideline-based surveillance to low incidence of colorectal dysplasia (CRD) and colorectal cancer (CRC).
  • Chromoendoscopy was underused.
  • Authors: 
    • "Meeting current...surveillance recommendations may result in low CRC rates in all IBD patients.”
    • “Surveillance earlier than 8 years in the absence of PSC (primary sclerosing cholangitis) is likely not indicated.”

Why this matters

Study design

  • Single-center retrospective cohort study of UC and colonic CD patients with ≥8 years of disease duration or concomitant PSC (n=680).
  • Outcomes: adherence to surveillance guidelines; incidence of CRC, dysplasia.
  • Funding: McGill CAS Research Support Program; Kimberly Sue McCall Award; Nesbitt-McMaster Award; Pfizer.

Key results

  • Median disease duration, 17 years.
  • UC and colonic CD, respectively:
    • Surveillance adherence: 76%, 66% (PSC: 33%).
    • Chromoendoscopy: 2.4%, 0%.
    • Biopsy adequacy: 54%, 29%.
    • Dysplasia detection: 7%, 3%, mostly low-grade dysplasia (LGD); 3 CRC cases found.
    • CRC incidence/100,000 patient-years: 19.5, 25.1.
    • High-grade dysplasia incidence/100,000 patient-years: 58.5, 37.6.
  • Before 8 years of disease duration in UC and CD:
    • Dysplasia: 19.5, 12.5/100,000 patient-years (PSC, 0).
    • CRC: none.

Limitations

  • Rates not population-based.