Colorectal cancer screening and surveillance in Crohn's colitis

Aims: To assess colonoscopic screening and surveillance for detecting neoplasia in patients with long-standing colonic Crohn's disease (CD). Patients and Methods: Colonoscopy and biopsy records from patients with colonic CD were evaluated at the Cedars-Sinai Inflammatory Bowel Disease Center during a 17-year period (1992-2009). Results: Overall, 904 screening and surveillance examinations were performed on 411 patients with Crohn's colitis (mean 2.2 examinations per patient). The screening and surveillance examinations detected neoplasia in 5.6% of the patient population; 2.7% had low-grade dysplasia (LGD) (n = 11), 0.7% had high-grade dysplasia (HGD) (n = 3), and 2.2% had carcinoma (anal carcinoma n = 3; rectal carcinoma n = 6). Mean age of CD diagnosis was 25.6 +/- 0.8 years in those with normal examinations, compared to 17.7 +/- 2.7 years (p < 0.001) in those with HGD, 36.85 +/- 1.43 in those with LGD (p = 0.021) and 28.32 +/- 3.24 years in those with any dysplasia/cancer (p = 0.034). Disease duration in patients with normal examinations was 19.1 +/- 0.5 years, compared to 36.8 +/- 4.4 years (p < 0.001) in HGD, 16.88 +/- 2.59 in those with LGD (p = 0.253) and 30.68 +/- 4.03 years in those with any dysplasia/cancer (p = 0.152). The mean interval between examinations was higher in HGD (31.5 +/- 9.4 months) compared to those with normal colonoscopies (12.92 +/- 1.250 months; p = 0.002). Conclusions: We detected cancer or dysplasia in 5.6% of patients with long-standing Crohn's colitis enrolled in a screening and surveillance program. Younger age at diagnosis of CD, longer disease course, and greater interval between exams were risk factors for the development of dysplasia. (c) 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.