Colonoscopy interval could be longer in some with IBD

Last Updated: 2018-05-30

By David Douglas

NEW YORK (Reuters Health) - Colonoscopy intervals could be safely increased in certain patients with endoscopically quiescent inflammatory bowel disease (IBD) and no additional risk factors for colorectal cancer, according to Dutch and U.S. researchers.

"We found that patients in whom two consecutive surveillance colonoscopies show quiescent disease and no high-risk features had a very low risk of future colorectal carcinoma," said Dr. Bas Oldenburg of University Medical Center Utrecht.

"These findings suggest that surveillance intervals can be increased in at least 40% of patients, thereby optimizing the cost and resource-to-benefit ratio and improving the quality of life of patients with IBD," he told Reuters Health by email.

People with long-standing colonic IBD are known to be at increased risk of colorectal cancer and are often enrolled in colonoscopic surveillance programs, Dr. Bas and colleagues note in Gut, online May 2.

Although European guidelines allow for a five-year surveillance interval in certain low-risk patients, the researchers point out that in North America, a one-year to two-year colonoscopic surveillance protocol is standard.

The researchers reviewed multinational data on 775 patients, all of whom had long-standing IBD colitis without high-risk features and underwent regular CRC surveillance.

Of these 340 (44%) had had at least one negative colonoscopy (i.e., no postinflammatory polyps, no strictures, no endoscopic disease activity and no evidence of neoplasia). A positive colonoscopy included at least one of these criteria.

Patients who had had at least one positive colonoscopy were were comparable to those with consecutive negative colonoscopies, with similar disease-related characteristics, number of surveillance colonoscopies and intervals between colonoscopies.

At a mean follow-up of 6.1 years after the index colonoscopy, no advanced colorectal neoplasia was seen in patients with consecutive negative colonoscopies, while the incidence was 0.29 to 0.76 per 100 patient-years in those with at least one positive colonoscopy (P=0.02).

Among limitations of the study, say the researchers, is that "because our database was strictly limited to surveillance colonoscopies, we did not specifically investigate whether intermittent flares between surveillance examinations significantly affect the neoplasia risk."

Dr. Bincy P. Abraham, director of the gastroenterology fellowship program at Houston Methodist Hospital, in Texas, told Reuters Health by email, "This is a positive, reassuring study for our IBD patients undergoing colon-cancer surveillance. Due to the increased colon cancer risk in IBD patients after 8 years of disease, our U.S. guidelines require us to survey patients every 1-2 years."

She added, "This retrospective study was designed well to include only appropriate low-risk IBD patients that had good bowel preparation, controlled disease, and high-quality surveillance by either appropriate segmental biopsies or chromoendoscopy."

Dr. Abraham, who was not involved in the study, concluded that the results are "perhaps the reassurance that we need to consider changing our society guidelines to increase surveillance interval to every 5 years for these low-risk patients and reduce overall burden to patients, providers, and health care costs."

SOURCE: https://bit.ly/2H4hogv

Gut 2018.