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News

Screening and surveillance colonoscopy in chronic Crohn's colitis

Periodic surveillance colonoscopy should be part of the routine management of chronic extensive Crohn's colitis, finds a study in the latest issue of Clinical Gastroenterology and Hepatology.

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In a previous study, Dr Sonia Friedman and colleagues followed 259 patients with chronic Crohn's colitis in a prospective colonoscopic surveillance program between 1980 and 1998. Results of this study showed a 22% chance of developing definite dysplasia or cancer by the fourth surveillance examination.

In this study, the research team updates the previous results, including data gathered between 1998 and 2005.

All patients included in the study had at least 7 years of Crohn's colitis affecting at least one third of the colon. The team recalled patients every 1 to 2 years or sooner if dysplasia was found.

They classified the pathology as normal, dysplasia (indefinite, low-grade [LGD], or high-grade [HGD]), or carcinoma. Lesions were classified as flat, polyp, or mass.

A total of 1424 examinations were performed on 259 patients.

During screening definite dysplasia or cancer was found in 7% of patients.
Clinical Gastroenterology and Hepatology

Of the 259 patients 90% had extensive colitis.

The team identified definite dysplasia or cancer in 7% of patients during screening examinations.

On surveillance examinations, a first finding of definite dysplasia or cancer was found in an additional 30 patients. Of these, 22 had LGD, 4 had HGD, and 4 had cancer.

The researchers calculated that 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.

Furthermore, the cumulative risk of detecting an initial finding of flat HGD or cancer after a negative screening colonoscopy was 7% by the 9th surveillance examination.

Dr Friedman’s team concluded, “Periodic surveillance colonoscopy should be part of the routine management of chronic extensive Crohn's colitis”.

Clin Gastroenterol and Hepatol 2008; 6(9): 993-8

12 September 2008

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