TY - JOUR
T1 - Incidence and Classification of Postcolonoscopy Colorectal Cancers in Inflammatory Bowel Disease
T2 - A Dutch Population-Based Cohort Study
AU - Wintjens, Dion S. J.
AU - Bogie, Roel M. M.
AU - van den Heuvel, Tim R. A.
AU - le Clercq, Chantal M. C.
AU - Oostenbrug, Liekele E.
AU - Romberg-Camps, Marielle J. L.
AU - Straathof, Jan-Willem
AU - Stassen, Laurents P. S.
AU - Masclee, Ad A. M.
AU - Jonkers, Daisy M. A. E.
AU - Sanduleanu, Silvia
AU - Pierik, Marie J.
PY - 2018/7
Y1 - 2018/7
N2 - 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.
AB - 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.
KW - Epidemiology
KW - endoscopy
KW - ULCERATIVE-COLITIS
KW - COLONOSCOPIC SURVEILLANCE
KW - SCREENING COLONOSCOPY
KW - DECLINING RISK
KW - METAANALYSIS
KW - CROHNS
KW - CARCINOMA
KW - CONSENSUS
KW - NEOPLASIA
U2 - 10.1093/ecco-jcc/jjy044
DO - 10.1093/ecco-jcc/jjy044
M3 - Article
C2 - 29648663
SN - 1873-9946
VL - 12
SP - 777
EP - 783
JO - Journal of Crohn's & Colitis
JF - Journal of Crohn's & Colitis
IS - 7
ER -