Search

P128 Colorectal cancer surveillance with chromoendoscopy in inflammatory bowel disease: results from a real life experience

C. Rubín De Célix Vargas, M. Chaparro, J.A. Moreno, C. Santander, J.P. Gisbert

Gastroenterology Unit, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa IIS-IP, Universidad Autónoma de Madrid. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBEREHD, Gastroenterology Unit, Madrid, Spain

Background

Patients with inflammatory bowel disease (IBD) are at increased risk for developing colorectal cancer (CRC). Recent practice guidelines suggest the use of chromoendoscopy with targeted biopsies to identify dysplastic lesions. The aim of this study was to know the dysplasia detection rate with chromoendoscopy in a real life cohort and to describe endoscopic characteristics of the lesions detected and their management.

Methods

Single-centre retrospective and observational study of all chromoendoscopies done between January 2016 and May 2019 in adult patients with left-sided/extensive ulcerative colitis or Crohn’s disease involving more than one-third of the colon. All polyp characteristics were collected (localisation, size, Paris and Kudo classifications) and their treatments received (endoscopic resection or surgery).

Results

One hundred and eighty-six chromoendoscopies on 160 patients were included. Of all chromoendoscopies, the dysplasia detection rate was 24% (23% of patients had dysplasia in any chromoendoscopy done during the period of the study). Ninety-two patients (57%) were men. Eighty-six (54%) had ulcerative colitis, 72 (45%) Crohn’s disease and 2 (1%) non-classifiable IBD. Twenty-five (15%) had family history of CRC. 118 (74%) received treatment with aminosalicylates, 67 (42%) with thiopurines and 42 (26%) with biologics. A total of 212 lesions were detected, 94% were located in areas of mucosa close to the segment affected by IBD. Most of them were located in the rectum (36%) and left colon (30%). More than half of the lesions were flat polyps (31% Paris 0-IIa, 25% Paris 0-IIb). The most frequent Kudo pit pattern was Kudo II (43%) and Kudo IIIs (33%). A total of 123 (58 %) lesions were non-neoplastic and 74 (35%) were neoplastic. Among these, 69 (93%) were low-grade dysplasia and five were high-grade dysplasia: 5/5 located in rectum, and one of them could not be suitable for endoscopic resection. Twelve lesions could not be retrieved. Only five patients (3%) required surgical treatment. In the univariate analysis, the presence of dysplasia was not related with age, sex, smoking, or type of IBD. Dysplastic lesions were more frequently localised distal to the splenic flexure (OR, 0.543; 95% CI, 0.30–0.99; p < 0.05) compared with non-dysplastic lesions; they were non-polypoid lesions: Paris 0-IIa, 0-IIb, 0-IIc (OR, 0.11; 95% CI, 0.02–0.59; p < 0.001). The polyp size was not a predictor of dysplasia.

Conclusion

This study reports a high dysplasia detection rate (24%) via targeted chromoendoscopic biopsies in a real life cohort. Endoscopic resection removed the lesions in most of the cases; only 3% of patients need surgery (partial colectomy). Our results underlines the importance of colorectal cancer surveillance in IBD patients.