Participation in Colonoscopic Cancer Surveillance among Patients with Ulcerative Colitis: Meeting Expectations?

Abstract

Purpose: To prevent colorectal cancer in ulcerative colitis (UC), major gastroenterology societies recommend an intensive program of colonoscopic screening/surveillance every 1–2 years beginning 8 years after disease onset. In patients without UC, rates of participation in colonoscopic screening programs have been well described. However in patients with UC, rates of participation in colonoscopic surveillance programs have not. Methods: We studied a previously described population-based cohort of 358 patients with left-sided (N = 151) or pancolonic (N = 207) ulcerative colitis who received care for at least 2 years within an integrated health care system and were eligible for screening colonoscopy based on duration of disease > 8 years. All procedures and pathology records were available electronically as part of clinical care. We determined 1) What proportion of patients underwent at least one screening/surveillance colonoscopy between 2001–2005; 2) what proportion of patients who underwent surveillance colonoscopy underwent a second surveillance within the recommended 1–2 years. Results: Among 358 prevalent cases of UC eligible for screening/surveillance between 2001–2005, 123 (34%) underwent at least one surveillance colonoscopy during this time period. Among 123 patients who underwent one surveillance exam, 64 (52%) underwent an additional surveillance colonoscopy within the recommended 1–2 years. Overall, 64 of the 358 patients (18%) who were eligible for surveillance adhered to the recommended surveillance guidelines. Conclusion: In an integrated health care system with access to colonoscopy, few patients with UC adhered to the recommended colonoscopic surveillance guidelines. If these guidelines represent the current standard of care, reasons for such poor rates of adherence must be further investigated. Furthermore, strategies to improve participation in colonoscopic surveillance must be developed.