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

Abstract

Background Patients with inflammatory bowel disease are at increased risk for colorectal cancer. The aim of this study was to know the prevalence of dysplasia and colorectal cancer with chromoendoscopy, to describe the characteristics and the management of the detected lesions and to identify possible risk factors of dysplasia in clinical practice. Methods Observational, retrospective study of all chromoendoscopies performed between January 2016 and May 2019 in patients with left-sided/extensive ulcerative colitis or Crohn's disease involving more than one-third of the colon. Information about all the polyps’ characteristics and the treatments received was collected. Results A total of 186 chromoendoscopies on 160 patients were reviewed; 57% were men; 54% had ulcerative colitis. The dysplasia detection rate was 24% and 212 lesions were detected: rectum (36%) and left colon (30%). Flat polyps were detected in 57% patients. In total, 123 (62%) lesions were non-neoplastic and 74 (38%) were neoplastic. Among these, 69 (93%) were low grade dysplasia and five (7%) were high grade dysplasia, all of them located in rectum. Two patients (1%) required surgery. During follow-up, no patient developed colorectal cancer. Age over 60 years, flat lesions, polyp >5 mm and right colon localization were found to be risk factors for dysplasia. Conclusions This study reports a high dysplasia detection rate (24%) via targeted chromoendoscopic biopsies. In most cases, lesions were successfully removed by endoscopic resection. Our results underline the importance of colorectal cancer surveillance in inflammatory bowel disease patients.