P257 Is colorectal screening in IBD fit for purpose?
Saeidinejad, M.(1);Dawson, H.E.(2)*;Newbury, C.M.(2);Searle, H.(2);Gordon, J.N.(2);
(1)University College London, Institute of Liver and Digestive Health-, London, United Kingdom;(2)Hampshire Hospitals NHS Foundation Trust, Gastroenterology, Winchester, United Kingdom;
Patients with IBD are at increased risk of CRC with it recommended that patients with longstanding colitis undergo regular surveillance endoscopy. However, there is conflicting evidence for the quality and effectiveness of IBD surveillance programmes. We undertook an audit of the effectiveness of our surveillance programme against national standards alongside a case-note review of cases of CRC arising in patients with IBD diagnosed over the same period.
Sequential colonoscopies for IBD surveillance at Hampshire Hospitals Foundation Trust from 01/01/2019 to 31/12/2020 were reviewed retrospectively. The quality of the surveillance endoscopy programme was assessed against the BSG and SCENIC guidelines. Patients with CRC and IBD were identified using the International Classification of Diseases coding system over the same period with subsequent case-note review of identified cases.
250 colonoscopies were reviewed with 6 excluded (3 inadequate bowel preparation, 3 severe active disease) leaving 244 for analysis. 203 (83.2%) were adherent to the guidelines. Non-compliance was either due to lack of dye-spray or inadequate number of biopsies (35 had 3-10 biopsies, 6 no biopsies). Overall, 2421 random biopsies were taken along with 90 targeted biopsies and/or polypectomies. 1 adenocarcinoma (0.45%), 1 HGD (sporadic polyp), 1 LGD, and 1 indefinite lesion were detected along with 19 sporadic polyps. During the same period 9 patients were diagnosed with CRC that were not in the surveillance programme. 3 had a diagnosis of probable pre-existing IBD made at the time of diagnosis of cancer (2 UC, 1 CD), 2 had a historical diagnosis of UC but were not known to secondary care, 1 was not under surveillance due to age (85), 2 had ileocaecal CD with CRC in unaffected segment of large bowel, and 1 had colitis <8 yrs.
Our audit showed that the quality of the surveillance endoscopy had improved since our previous audit (2016) with the majority of cases now undertaken with dye-spray, and less cases undertaken by non-specialist endoscopists. Though there remains room for improvement with 16.8% non-complaint primarily due to inadequate biopsies, it was reassuring that 83.2% of procedures were performed in adherence with current guidance. Despite this only 1/10 (10%) of cases of CRC in patients with IBD were picked up through surveillance with 9/10 (90%) diagnosed in patients with IBD outside the programme. These results suggest that targeting resources at improving the surveillance programme further is likely to have a limited impact on reducing CRC in patients with IBD and that research is needed to identify and address why the majority of IBD patients that develop CRC are not reached by current surveillance strategies.