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P256. Dysplasia and colorectal cancer in surveillance colonoscopies of ulcerative colitis in a single center: retrospective study

N. Hernandez1, M. Peñate1, P. Saiz1, A. Monescillo1, E. Jimenez1, M.A. Sánchez2, A. Castellot1, J.M. Marrero1, A. Sierra1, 1Hospital Universitario Insular de Gran Canaria, Servicio Aparato Digestivo, Las Palmas de Gran Canaria, Spain, 2Hospital Universitario Insular de Gran Canaria, Servicio Anatomía Patológica, Las Palmas de Gran Canaria, Spain

Background

Inflammatory bowel disease is one of the predisposing conditions for cancer colorectal and it is preceded by dysplasia. Although no large controlled trial has proven that surveillance reduces mortality, it is recommended by the mayor Societies. Our objectives were (1) evaluate in our hospital dysplasia and CRC diagnosed by conventional colonoscopy in our patients with UC undergoing colonoscopy surveillance based standard recommendations, to introduce chromoendoscopy into our protocols and (2) assess homogeneity in the sampling according to the guidelines.

Methods

Retrospective study in patients with UC who were under surveillance endoscopy of dysplasia/CRC in the last 5 years. The data were obtained from reports of colonoscopy and pathology. In cases of dysplasia or CRC, medical records were reviewed.

Results

254 colonoscopies in 130 patients: 52% males, mean age: 51±13 years. Location at diagnosis: proctitis (E1) 16%, left colitis (E2) 49% and extensive (E3) 31%. Mean duration of disease was 15±6 years. 2.4±2 colonoscopies were performed in each patient. 93% completes; no endoscopy activity in 71% and activity histology in 53%. The total number of biopsies ranged between 25–30 in 14 colonoscopies. Polypoid lesions 69% (35% multiples): appearance inflammatory pseudopolyps 37% (histology features 100%). Sporadic adenomas 1.5% (4), mean age 60 years without cancer risk, in an area without endoscopic and histology inflammation: 1 right, 2 left colon and 1 rectum; 3 adenomas and 1 in situ carcinoma. Dysplasia: 2.7% (7), 8 dysplasia (2 in the same): high grade 2 (25%) and low grade 6 (75%). Low-grade flat dysplasia: 5 (63%), DALM or dysplasia associated mass 1 (13%), high-grade flat dysplasia 1 (13%). Treatments all 5-ASA, 3 AZA and 1 IFX. 1 CEP. CRC 0.7% (2) with age at diagnosis 51 years, in treatment with 5-ASA. Location 1 left colon and synchronous lesion in left and right colon. Histological adenocarcinoma. No CEP.

Conclusion

(1) Although the percentage dysplasia/CRC is low in our series, it is there. (2) Significantly associated with histologic activity and extend of disease at diagnosis, so that mucosal and histological healing must be the objective medical treatment. (3) Multiple polypoid lesions were found which makes difficult the blind sampling (4) As general population, sporadic adenomas appear to old age. (5) Random sampling was homogeneous. In conclusion it would useful endoscopic techniques for surveillance allow guided biopsies to increased sensibility and decrease complexity.