Search in the Abstract Database

Search Abstracts 2011

* = Presenting author

19. Incidence of dysplasia and colorectal cancer in patients with ulcerative colitis included in the Spanish ENEIDA registry

J. Gordillo1, E. Domènech2, J. Panés3, F. Gomollón4, M. Andreu5, M. Peñalva6, I. Vera7, J.P. Gisbert8, J. Barrio9, M. Esteve10, O. Merino11, E. Garcia Planella1

1Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 2Hospital Germans Trias i Pujol, Badalona, Spain; 3Hospital Clínic i Provincial, Barcelona, Spain; 4Hospital Universitario Lozano Blesa, Zaragoza, Spain; 5Hospital del Mar, Barcelona, Spain; 6Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Spain; 7Hospital Universitario Puerta del Hierro, Madrid, Spain; 8Hospital Universitario de la Princesa, Madrid, Spain; 9Hospital Universitaro Rio Hortega, Valladolid, Spain; 10Hospital Mútua de Terrassa, Terrassa, Spain; 11Hospital de Cruces, Bilbao, Spain

Introduction: Patients with longstanding ulcerative colitis (UC) have an increased risk for the development of colorectal cancer (CRC), and colonoscopic surveillance to detect dysplasia and/or CRC is recommended. Recent studies suggest a reduction in CCR/dysplasia risk in UC in the last years, but this hasn't been accurately assessed.

Aims: To evaluate the incidence of dysplasia/CRC and associated risk factors in a large Spanish database (ENEIDA).

Material and Methods: 5,086 UC cases from the ENEIDA Registry were initially included. Patients in whom no colonoscopies were performed or did it before the diagnosis of UC were excluded. In addition to clinical and epidemiological features, endoscopic findings in terms of CRC and high-grade, low-grade or indeterminate dysplasia were recorded.

Results: 831 patients (34% left-sided UC, 56% extensive UC) were included. Median time from UC diagnosis was 19±9 years. Among known risk factors for CRC: primary sclerosing cholangitis (PSC) 3% and family history of CRC 7%. Ninety per cent of patients were on oral mesalazine at any time during UC course. A total of 1866 colonoscopies were performed (median per patient = 1, IQR = 1–3). Median time from UC diagnosis to first colonoscopy was 11 years (IQR = 8–16) for extensive UC, and 13 years (IQR = 10–18) for left-sided UC. Twenty-six cases of CRC were found (median time from UC diagnosis to CRC diagnosis = 11.5 years, IQR = 4.7–20.2; 27% of them within the first 8 years from UC diagnosis). Moreover, 262 dysplasias (26 high grade dysplasia – HGD – and 234 low grade/indeterminate for dysplasia) were found in 160 patients. The cumulative probability of developing HGD/CRC was 1.2%, 2%, 4.8% and 11.1% at 5, 10, 20, and 30 years of disease, respectively. The risk of HGD/CRC remained the same at any time during UC course. PSC and male gender were independent predictors for the development of HGD/CRC ([RR 13.5, IC95% 4.3–42; p < 0.017] and [RR 2.9, IC95% 1.2–7; p < 0.001], respectively); whereas the use of immunomodulators and being included in a colonoscopy surveillance program were independent protective factors ([RR 0.23, IC95% 0.08–0.64; p = 0.005] and [RR 0.33, IC95% 0.15–0.72; p = 0.005], respectively).

Conclusion: HGD/CRC incidence in Spain seems to be lower than previously reported in other areas. Otherwise, this risk seems to exist since UC diagnosis. Prospective, poblational studies are warranted in order to optimise colonoscopy surveillance programs.