Screening and surveillance colonoscopy in chronic Crohn's colitis: results of a surveillance program spanning 25 years

Clin Gastroenterol Hepatol. 2008 Sep;6(9):993-8; quiz 953-4. doi: 10.1016/j.cgh.2008.03.019. Epub 2008 Jun 27.

Abstract

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.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Colonic Neoplasms / diagnosis*
  • Colonic Neoplasms / epidemiology
  • Colonoscopy*
  • Crohn Disease / complications*
  • Female
  • Humans
  • Incidence
  • Male
  • Mass Screening
  • Middle Aged
  • Prospective Studies