P397 Surveillance in ulcerative colitis: Can we predict the risk for intraepithelial neoplasia?
J. Estorninho1, P. Freire2, S. Lopes1, M. Ferreira1, M. Ferreira1, F. Portela1, P. Figueiredo1
1Centro Hospitalar e Universitário de Coimbra, Serviço de Gastrenterologia, Coimbra, Portugal, 2Faculdade de Medicina da Universidade de Coimbra, Gastrenterologia, Coimbra, Portugal
Background
Ulcerative colitis (UC) has been associated with an increased risk of colorectal cancer (CRC). Although dye spray chromoendoscopy showed superiority to standard colonoscopy in surveillance studies, with the availability of higher-resolution colonoscopes, the utility of chromoendoscopy (CE) has been questioned. We aimed to evaluate the risk of intraepithelial neoplasia (IN) after a high-quality screening colonoscopy (making use of CE or random biopsies (RB) and removing all detected lesions) in a population with longstanding UC and to identify potential risk factors for dysplasia incidence.
Methods
In a previous study, 145 patients with clinically and endoscopic longstanding (≥8 yr) distal/extensive UC without primary sclerosing cholangitis and/or history of IN were prospectively randomised to undergo CE or RB. In this study, after a median follow-up of 5 additional years, we evaluated subsequent IN incidence in these patients, submitted to surveillance colonoscopy. Patients without high-quality surveillance colonoscopy (with good bowel preparation and cecum intubation) using high-definition were excluded.
Results
One hundred and twenty-one patients were included. Nine had removed adenomas with low-grade dysplasia in the index colonoscopy. Now, in surveillance colonoscopy, we detected 9 (7.4%) IN: low-grade dysplasia was found in 8 (6.6%) patients and a colorectal adenocarcinoma in 1 (0.008%) patient. After multivariate analysis, IN was significantly associated with older age (68 vs. 52 years,
Conclusion
In this study, older patients and higher disease duration were associated with a higher risk of IN in surveillance colonoscopy.