Patients with primary sclerosing cholangitis and colitis are at risk of developing dysplasia and colorectal cancer.
Consequently, annual surveillance colonoscopy with random biopsies is recommended.
Dr Remo Panaccione and colleagues from Canada determined the incidence of dysplasia or colorectal cancer to assess surveillance practices.
The research team also assessed the costs associated with surveillance of primary sclerosing cholangitis patients.
The team conducted a population-based study between 2000 and 2004 to identify all patients with a diagnosis of primary sclerosing cholangitis using regional databases.
Colonic histopathology reports of primary sclerosing cholangitis patients with colitis were reviewed.
|The cost of surveillance to detect 1 case of dysplasia was $26,495|
|Inflammatory Bowel Diseases|
The researchers determined the frequency of surveillance colonoscopies performed between 2000 and 2005.
In addition, the number of biopsies retrieved, and the presence of colorectal cancer or dysplasia was determined.
The cost of annual surveillance colonoscopy with 33 random biopsies to detect 1 additional case of dysplasia was calculated from a local costs database.
The research team identified 45 primary sclerosing cholangitis patients with ulcerative colitis or Crohn's disease.
The team noted that 11% of patients were diagnosed with low-grade dysplasia, dysplasia-associated lesion or mass, or colorectal cancer during the 5-year follow-up.
The incidence rate was 3 events per 100 person-years.
The researchers detected 2 of these lesions through surveillance, and 3 because of symptomatic presentation.
Only 36% of the expected number of surveillance colonoscopies were performed.
The median number of biopsies collected was 27.
The cost of surveillance to detect 1 additional case of dysplasia was $26,495.
Dr Panaccione's team concludes, "Despite a high rate of colorectal dysplasia or colorectal cancer among primary sclerosing cholangitis patients, surveillance was suboptimal."