Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn’s colitis patients in the Netherlands

Rijn, Anne F. van; Fockens, Paul; Siersema, Peter D.; Oldenburg, Bas

doi:10.3748/wjg.15.226

Cited by 73 publications

(28 citation statements)

References 13 publications

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“…Our finding was consistent with prior studies of varied compliance with practice guidelines, in particular the low use of surveillance colonoscopy (25%) for patients with longstanding UC in an integrated healthcare delivery system in the USA [18,19,20,21,22]. IBD patients in our study sample presumably had CRC associated with longstanding colitis, although the retrospective nature of our study precluded detailed information on the duration, extent and severity of colitis.…”

Section: Discussionsupporting

confidence: 82%

“…Adherence to surveillance colonoscopy guidelines for patients with ulcerative colitis (UC) has varied in clinical practice. Surveys of gastroenterologists showed that most gastroenterologists performed some form of surveillance for UC patients [18,19,20]. However, one survey suggested that only about half of IBD specialists and community gastroenterologists would recommend surveillance colonoscopy for a hypothetical patient with left-sided colitis [21].…”

Section: Introductionmentioning

confidence: 99%

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Use of Surveillance Colonoscopy in Medicare Patients with Inflammatory Bowel Disease prior to Colorectal Cancer Diagnosis

et al. 2014

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Background: Patients with longstanding inflammatory bowel disease (IBD) involving large intestine proximal to rectum are considered to be at increased risk for colorectal cancer (CRC). One prior study showed low utilization of surveillance colonoscopy in patients with ≥8 years of ulcerative colitis (UC) in the USA. Aims: To study use of surveillance colonoscopy among Medicare beneficiaries with IBD in the 2-year period prior to CRC diagnosis. Data and Methods: Our study sample included Medicare beneficiaries in the SEER-Medicare-linked database who were diagnosed with CRC during 2001-2005 and had ≥3 physician visits with ICD-9 diagnosis code for IBD prior to CRC diagnosis. Medicare beneficiaries aged >85 years without Part B coverage or enrolled in HMOs were excluded. Colonoscopy performed within 6-30 months prior to CRC diagnosis was defined as surveillance colonoscopy. The χ² test and multivariate logistic regression were used in statistical analysis. Results: Of 241 Medicare beneficiaries with IBD and diagnosed with CRC, 92 (38%) patients underwent ≥1 surveillance colonoscopy in the 2 years prior to cancer diagnosis. The use of surveillance colonoscopy was similar between Crohn's disease (28/86, 33%) and UC (64/155, 41%). In multivariate logistic regression, older age (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-0.99) was negative associated with surveillance colonoscopy use and personal history of colon polyp (OR 2.73, 95% CI 1.09-6.87) was positively associated with surveillance colonoscopy use. Conclusions: Use of surveillance colonoscopy was low among Medicare beneficiaries with IBD in the 2 years prior to CRC diagnosis.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Use of Surveillance Colonoscopy in Medicare Patients with Inflammatory Bowel Disease prior to Colorectal Cancer Diagnosis

et al. 2014

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“…This might be explained by the fact that only 12 % of our patients were included in a dysplasia surveillance programme before development of CRC, against a slightly higher percentage (15 %) in the academic cohort. Surveillance colonoscopies are not yet common practice in general hospitals in the Netherlands and most gastroenterologists in the Netherlands do not adhere to surveillance guidelines [25]. This low adherence to colonoscopy surveillance in IBD patients reflects clinical practice in general hospitals with a presumed perception of low CRC risks in these populations.…”

Section: Discussionmentioning

confidence: 99%

Age at diagnosis of inflammatory bowel disease influences early development of colorectal cancer in inflammatory bowel disease patients: a nationwide, long-term survey

et al. 2012

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BackgroundData on clinical characteristics of patients with inflammatory bowel disease (IBD)-related colorectal cancer (CRC) are scarce and mainly originate from tertiary referral centres. We studied patient and disease characteristics of IBD-related CRC in a nationwide IBD cohort in general hospitals. Main outcome parameters were time to develop CRC, and factors associated with early CRC development.MethodsAll IBD patients diagnosed with CRC between 1 January 1990 and 1 July 2006 were identified using a nationwide automated pathology database (PALGA). Patient charts were assessed to confirm diagnosis and collect clinical data. Early CRC was defined as CRC diagnosed less than 8 years after IBD diagnosis. Statistical analysis was performed using descriptive statistics, independent t tests, binary logistic regression and Cox-regression analysis.ResultsDiagnosis of IBD-related CRC was confirmed in 251 patients (171 ulcerative colitis, 77 Crohn’s disease, 3 unclassified colitis), 161 males (64 %). Median time from IBD diagnosis to CRC diagnosis was 12 years (IQR 4–20); 89 patients (35 %) developed early CRC. Type of IBD, gender, concomitant PSC, pseudopolyps, extent of inflammation, and medication use were not related to early CRC (p > 0.05). IBD diagnosis at older age (HR for 10 years older age 2.25; 95 % CI 1.92–2.63) was related to early CRC. Twenty-three patients (12 %) had been included in a surveillance programme prior to CRC diagnosis. Patients in the surveillance group had a significantly better tumor stage (p = 0.004).ConclusionsWe emphasize the problem of a high proportion of IBD-associated CRCs developing before the recommended start of surveillance. Therefore, we suggest that older age at IBD onset could be an additional factor to start surveillance in IBD patients.

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“…(90) Furthermore, the overall utilization of surveillance colonoscopy programs at the population level has been demonstrated to be low, with only a quarter of patients undergoing surveillance at recommended intervals. (91, 92) Even among high risk individuals (PSC), adherence to guidelines is reported to be less than 40%. (91–94) Thus, irrespective of the interval or strategy followed, adherence to any surveillance program would be considered an optimization of current practices.…”

Section: Screening and Surveillancementioning

confidence: 99%

“…Providers have traditionally failed to comply with biopsy protocols, with some reports documenting adherence to be less than 5%. (92, 93, 95, 96) It is unclear if this variation in practice and adherence to surveillance techniques is due to patient preferences, provider practice preferences, or technical challenges (i.e. time required to submit multiple biopsies in multiple sample jars),(97) but it may help to explain why the rate of early/missed CRC after colonoscopy is reported to be nearly 15% among IBD patients as compared to only 5% in non-IBD patients.…”

Section: Screening and Surveillancementioning

confidence: 99%

Colorectal Cancer and Dysplasia in Inflammatory Bowel Disease: A Review of Disease Epidemiology, Pathophysiology, and Management

Dulai

Sandborn

Gupta

2016

Cancer Prevention Research

154

108

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Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) characterized by recurrent episodes of mucosal inflammation. This chronic mucosal inflammation has several potential consequences, one of which is the occurrence of colitis associated colorectal cancer (CRC). Over the past decade our understanding of the epidemiology, pathophysiology, and overall approach to diagnosing and managing colitis associated CRC, has grown considerably. In the current review article, we outline these advancements and highlight areas in need of further research.

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Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn’s colitis patients in the Netherlands

Cited by 73 publications

References 13 publications

Use of Surveillance Colonoscopy in Medicare Patients with Inflammatory Bowel Disease prior to Colorectal Cancer Diagnosis

Use of Surveillance Colonoscopy in Medicare Patients with Inflammatory Bowel Disease prior to Colorectal Cancer Diagnosis

Age at diagnosis of inflammatory bowel disease influences early development of colorectal cancer in inflammatory bowel disease patients: a nationwide, long-term survey

Colorectal Cancer and Dysplasia in Inflammatory Bowel Disease: A Review of Disease Epidemiology, Pathophysiology, and Management

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