Low colonoscopic surveillance among IBD patients with longstanding colitis
MedWire News: Study findings show that only half of inflammatory bowel disease (IBD) patients with longstanding extensive colitis (LEC) undergo surveillance colonoscopy over a 3-year period.
"The suboptimal and highly variable implementation of control methods observed here in real-life practice is unacceptable and calls for urgent corrective measures," say Laurent Beaugerie (Saint-Antoine Hospital, Paris, France) and co-authors.
The findings are of clinical importance given that patients with LEC are at high risk for developing colonic epithelial dysplasia and carcinoma.
"There is good international agreement that patients with IBD and extensive colitis should have surveillance colonoscopy every 1-3 years," say the researchers.
As part of the CESAME (Cancers Et Surrisque Associé aux Maladies inflammatoires chroniques de l'intestin En France) study, patients with more than a 7-year history of extensive colitis were sent a questionnaire covering previous medical history, colectomy, current pharmacotherapies, and colonoscopy history between 2004 and 2007.
In total, 583 patients provided information spanning a median period of 41 months, with details of colonoscopic procedures and histological findings available for 440 colonoscopies among 270 patients.
The researchers found that only 54% of patients with LEC had undergone at least one surveillance colonoscopy during the follow-up period. Significant variations in surveillance colonoscopy rates were seen across the nine participating centers, ranging from 27% to 70%.
"The massive intercenter variation observed in our study points rather to a role of physician-related factors in suboptimal surveillance, and particularly poor awareness of the benefits of surveillance," write Beaugerie et al in the journal Alimentary Pharmacology and Therapeutics.
Patients with Crohn's disease were monitored significantly more often than patients with ulcerative colitis (UC) or unclassified IBD, at 69% versus 48%, respectively. The research team says that there is no good theoretical reason to adapt endoscopic surveillance to the IBD subtype, given that rates of excess colorectal cancer were similar in both patient subtypes in the CESAME cohort.
Independent predictors of surveillance were male gender, UC subtype, longer disease duration, previous history of colorectal cancer, and management in a center with a large IBD patient population.
Random biopsies, chromoendoscopy, and targeted biopsies were performed during 71%, 30%, and 27% of surveillance colonoscopies. Four patients in the study were diagnosed with advanced-stage colonic neoplasia during the study period. Two of the cases were diagnosed in patients who did not have endoscopic surveillance.
The researchers conclude: "In addition to better education of gastroenterologists and patients, elaboration of specific guidelines in Crohn's disease, systematic mailing proposal for colonoscopic surveillance to patients at risk, and greater [involvement] of patient associations and health authorities could be considered."
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By Ingrid Grasmo