Incidence and classification of postcolonoscopy colorectal cancers in inflammatory bowel disease: A Dutch population-based cohort study.
J Crohns Colitis. 2018 Apr 10;:
Authors: Wintjens DSJ, Bogie RMM, van den Heuvel TRA, le Clercq CMC, Oostenbrug LE, Romberg-Camps MJL, Straathof JW, Stassen LPS, Masclee AAM, Jonkers DMAE, Sanduleanu-Dascalescu S, Pierik MJ
Background and Aims: Patients with inflammatory bowel disease (IBD) colitis are at increased risk for colorectal cancer (CRC). We examined the proportion and most likely aetiology of potentially preventable postcolonoscopy CRCs (PCCRCs) in a population-based cohort. Furthermore, adherence to IBD surveillance guidelines was evaluated in both PCCRCs and the remainder of prevalent CRCs.
Methods: All IBD patients diagnosed from 1991 to 2011 in the South Limburg region of The Netherlands (i.e. IBDSL cohort) were included. CRC cases were cross-checked with the Dutch pathology database and cancer registry. PCCRCs were defined as cancers diagnosed within 6-60 months after a colonoscopy and were classified as attributable to ‘inappropriate surveillance interval’, ‘inadequate bowel examination’, ‘incomplete resection’, ‘missed lesion’ or ‘newly developed cancer’.
Results: Twenty CRC cases were identified during 25,931 patient years of follow-up in 2,801 patients. The proportion of PCCRCs was 45.0%. Of these, 55.6% could be considered a ‘missed lesion’, while other possible aetiologies occurred only once. Considering both PCCRCs (n=9) and prevalent CRCs (n=11), ten were detected after publication of the surveillance guideline, but only three patients were enrolled. Moreover, 6 CRCs (30.0%) were detected before the recommended start of surveillance.
Conclusions: In the IBDSL cohort, 45.0% of all CRCs were considered to be PCCRCs, mainly classified as missed lesions. Additionally, a large proportion of CRCs in our cohort were observed before a surveillance endoscopy was performed. Therefore, stringent adherence to IBD surveillance guidelines, improving endoscopy techniques and adjusting the surveillance program may lead to a decrease in CRC incidence.
PMID: 29648663 [PubMed – as supplied by publisher]