P049 Correlation of Surgical Pathology With Preoperative Colonoscopy in Patients With IBD

Abstract

BACKGROUND: Previous studies have shown a very high rate of advanced neoplasia including cancer among patients referred for colectomy for dysplasia detected during surveillance colonoscopy. Our goal was to re-evaluate this correlation using a more recent cohort of patients from a single IBD center. METHODS: This is a single center, retrospective study of IBD patients who underwent colectomy for any indication from 1998 to 2017. Patients who underwent colonoscopy before colectomy were included. Demographic and clinical variables as well as the colonoscopy to surgery interval were collected from medical records. Pathological findings including location, lesion type and grade were compared between surgery and colonoscopy using the Spearman correlation index. Variables associated with discordant findings were also determined using regression analysis. RESULTS: A total of 192 patients with IBD (31.8% CD, 68.2% UC) underwent colectomy and all but 2 preceding colonoscopies were performed with white light (median interval t months, range s-z). All but 2 colonoscopies were performed with white light only. 52 patients had neoplasia in the resected specimen: 10 adenocarcinoma (Ca), 7 HGD, 30 LGD, 3 indefinite and 2 were sessile serrated lesion (SSL). Colonoscopy identified 4 patients with Ca, 4 with HGD, 1 LGD, and 1 SSL. The correlation between surgical and endoscopic pathological findings was modest (r = X, P = z). The following variables were associated with a missed diagnosis of advanced neoplasia during colonoscopy in univariate and multivariate analysis (a, b, c, d, e.g. male sex, moderate-severely active disease, standard vs. HD imaging and length of time between colonoscopy and surgery). CONCLUSION(S): These findings confirm a poor correlation between pre- and postoperative findings when using white light colonoscopy in patients with IBD. Image enhanced colonoscopy may reduce the rate of discordant results but this needs to be addressed in a prospective fashion.