Incidence and Classification of Postcolonoscopy Colorectal Cancers in Inflammatory Bowel Disease: A Dutch Population-Based Cohort Study

J Crohns Colitis. 2018 Jun 28;12(7):777-783. doi: 10.1093/ecco-jcc/jjy044.


Background and aims: Patients with inflammatory bowel disease [IBD] colitis are at increased risk for colorectal cancer [CRC]. We examined the proportion and most likely aetiology of potentially preventable postcolonoscopy CRCs [PCCRCs] in a population-based cohort. Furthermore, adherence to IBD surveillance guidelines was evaluated in both PCCRCs and the remainder of prevalent CRCs.

Methods: All IBD patients diagnosed from 1991 to 2011 in the South Limburg region of The Netherlands [i.e. IBDSL cohort] were included. CRC cases were cross-checked with the Dutch pathology database and cancer registry. PCCRCs were defined as cancers diagnosed within 6-60 months after a colonoscopy and were classified as attributable to 'inappropriate surveillance interval', 'inadequate bowel examination', 'incomplete resection', 'missed lesion' or 'newly developed cancer'.

Results: Twenty CRC cases were identified during 25,931 patient years of follow-up in 2,801 patients. The proportion of PCCRCs was 45.0%. Of these, 55.6% could be considered a 'missed lesion', while other possible aetiologies occurred only once. Considering both PCCRCs [n=9] and prevalent CRCs [n=11], ten were detected after publication of the surveillance guideline, but only three patients were enrolled. Moreover, 6 CRCs [30.0%] were detected before the recommended start of surveillance.

Conclusions: In the IBDSL cohort, 45.0% of all CRCs were considered to be PCCRCs, mainly classified as missed lesions. Additionally, a large proportion of CRCs in our cohort were observed before a surveillance endoscopy was performed. Therefore, stringent adherence to IBD surveillance guidelines, improving endoscopy techniques and adjusting the surveillance program may lead to a decrease in CRC incidence.

MeSH terms

  • Adenocarcinoma / classification
  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / epidemiology*
  • Adenocarcinoma / etiology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Colonoscopy*
  • Colorectal Neoplasms / classification
  • Colorectal Neoplasms / diagnostic imaging
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / etiology*
  • Diagnostic Errors
  • Early Detection of Cancer
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Incidence
  • Inflammatory Bowel Diseases
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Population Surveillance*
  • Practice Guidelines as Topic
  • Registries