Adherence to endoscopic surveillance for advanced lesions and colorectal cancer in inflammatory bowel disease: an AEG and GETECCU collaborative cohort study

Abstract

Summary Background and Aims Patients with colonic inflammatory bowel disease (IBD) have a high risk of colorectal cancer (CRC). Current guidelines recommend endoscopic surveillance, yet epidemiological studies show poor compliance. The aims of our study were to analyse adherence to endoscopic surveillance, its impact on advanced colorectal lesions, and risk factors of non‐adherence. Methods A retrospective multicentre study of IBD patients with criteria for CRC surveillance, diagnosed between 2005 and 2008 and followed up to 2020, was performed. Following European guidelines, patients were stratified into risk groups and adherence was considered when surveillance was performed according to the recommendations (±1 year). Cox‐proportional regression analyses were used to compare the risk of lesions. p‐values below 0.05 were considered significant. Results A total of 1031 patients (732 ulcerative colitis, 259 Crohn’s disease and 40 indeterminate colitis; mean age of 36 ± 15 years) were recruited from 25 Spanish centres. Endoscopic screening was performed in 86% of cases. Adherence to guidelines was 27% (95% confidence interval, CI = 24–29). Advanced lesions and CRC were detected in 38 (4%) and 7 (0.7%) patients respectively. Adherence was associated with increased detection of advanced lesions (HR = 3.59; 95% CI = 1.3–10.1; p = 0.016). Risk of delay or non‐performance of endoscopic follow‐up was higher as risk groups increased (OR = 3.524; 95% CI = 2.462–5.044; p < 0.001 and OR = 4.291; 95%CI = 2.409–7.644; p < 0.001 for intermediate‐ and high‐ vs low‐risk groups). Conclusions Adherence to endoscopic surveillance allows earlier detection of advanced lesions but is low. Groups at higher risk of CRC are associated with lower adherence.

Colorectal Cancer in Ulcerative Colitis: Mechanisms, Surveillance and Chemoprevention

“…Among them, 13%, 34% and 39% of patients did not perform or delayed follow-up procedures, respectively ( p < 0.001). Groups at higher risk of CRC are associated with lower adherence [ 126 ]. The possible reasons mentioned may be transportation, finances and discomfort with the procedure or bowel preparation as barriers to endoscopic surveillance adherence [ 127 ].…”

Adherence to endoscopic surveillance guidelines for patients with inflammatory bowel disease: An Australian cohort study

“…A large Spanish multicenter study reported adherence to the European Crohn's and Colitis Organisation surveillance guidelines for 43% for first surveillance colonoscopy and a total adherence of only 27% of their patients. 27 Chromoendoscopy was performed in 25% of initial procedures and 38% of subsequent surveillance procedures. A representative IBD cohort based on a sequential clinical attendance over a 6-month period at a Canadian center demonstrated adherence to surveillance guidelines of 76% and 82% for UC and colonic CD, respectively.…”

“…Another factor that has previously been identified is clinicians not being aware of surveillance recommendations or not organizing surveillance procedures. 27 All clinicians involved in this study had knowledge and access to the Australian guidelines for IBD surveillance. These guidelines were included as part of the national clinical practice guidelines for the prevention, early detection, and management of CRC, created by the Cancer Council Australia and approved by the National Health and Medical Research Council of Australia.…”

“…[21][22][23][24] Only a few studies have evaluated adherence with these guidelines, and these demonstrate poor adoption in clinical practice. [25][26][27] The initial Australian surveillance guidelines published in 2011 risk stratify IBD patients as low, intermediate, or high risk based on the presence of various risk factors, with surveillance intervals ranging from annually to five yearly. 28 These guidelines recommend the use of chromoendoscopy, a technique that involves spraying soluble dyes (methylene blue or indigo carmine) via a spray catheter or foot pump during the withdrawal aspect of a colonoscopy.…”

“…Several societal and international guidelines have been introduced to provide recommendations on surveillance intervals and standards 21–24 . Only a few studies have evaluated adherence with these guidelines, and these demonstrate poor adoption in clinical practice 25–27 …”