Screening and Surveillance Colonoscopy in Chronic Crohn's Colitis: Results of a Surveillance Program Spanning 25 Years

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Clinical Gastroenterology and HepatologyArticle in Press, Corrected Proof

doi:10.1016/j.cgh.2008.03.019 Copyright © 2008 AGA Institute Published by Elsevier Ltd.

Screening and Surveillance Colonoscopy in Chronic Crohn's Colitis: Results of a Surveillance Program Spanning 25 Years

Friedman, , , H. Rubin‡, Carol Bodian§, Noam Harpaz and h. Present‡

‡Department of Medicine, Mount Sinai Medical Center, New York, New York

Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts

Department of Pathology, Mount Sinai Medical Center, New York, New York

§Department of Anesthesiology, Mount Sinai Medical Center, New York, New York

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Background & Aims

Since 1980, we have followed 259 patients with chronic Crohn's colitis in a prospective colonoscopic surveillance program. Our initial results through August 1998 showed a 22% chance of developing definite dysplasia or cancer by the fourth surveillance examination. We now update the results of all examinations since September 1998 until April 2005.

Methods

All patients had at least 7 years of Crohn's colitis affecting at least one third of the colon. Patients were recalled every 1 to 2 years or sooner if dysplasia was found. Pathology was classified as normal, dysplasia (indefinite, low-grade [LGD], or high-grade [HGD]), or carcinoma. Lesions were classified as flat, polyp, or mass.

Results

A total of 1424 examinations were performed on 259 patients. Ninety percent had extensive colitis. The median age at diagnosis was 22 years (range, 2–61 y), and the median disease duration was 18 years (range, 7–49 y). On screening examination, definite dysplasia or cancer was found in 18 patients (7%). Thirteen had LGD, 2 had HGD, and 3 had cancer. On surveillance examinations, a first finding of definite dysplasia or cancer was found in an additional 30 patients (14%). Twenty-two had LGD, 4 had HGD, and 4 had cancer. The cumulative risk of detecting an initial finding of any definite dysplasia or cancer after a negative screening colonoscopy was 25% by the 10th surveillance examination. The cumulative risk of detecting an initial finding of flat HGD or cancer after a negative screening colonoscopy was 7% by the ninth surveillance examination.

Conclusions

Periodic surveillance colonoscopy should be part of the routine management of chronic extensive Crohn's colitis.

Abbreviations: CA, carcinoma; HGD, high-grade dysplasia; IBD, inflammatory bowel disease; IND, indefinite; IPAA, ileal pouch-anal anastamosis; LGD, low-grade dysplasia; SEER, Surveillance Epidemiology and End Results; TPC, total proctocolectomy