Quality of Surveillance Impacts the Colitis-Associated Advanced Neoplasia Risk: A Multicenter Case-Control Study

Maarten Te Groen; Monica Derks; Nathan den Broeder; Charlotte Peters; Gerard Dijkstra; Annemarie de Vries; Tessa Romkens; Carmen Horjus; Nanne de Boer; Michiel de Jong; Iris Nagtegaal; Lauranne Derikx; Frank Hoentjen

doi:10.1016/j.cgh.2022.12.010

Quality of Surveillance Impacts the Colitis-Associated Advanced Neoplasia Risk: A Multicenter Case-Control Study

Clin Gastroenterol Hepatol. 2024 Feb;22(2):357-367.e5. doi: 10.1016/j.cgh.2022.12.010. Epub 2022 Dec 23.

Authors

Affiliations

¹ Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: maarten.tegroen@radboudumc.nl.
² Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands.
³ Department of Gastroenterology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.
⁴ Department of Gastroenterology, Groningen University Medical Center, Groningen, the Netherlands.
⁵ Department of Gastroenterology, Erasmus Medical Center, Rotterdam, the Netherlands.
⁶ Department of Gastroenterology, Jeroen Bosch Hospital, Den Bosch, the Netherlands.
⁷ Department of Gastroenterology, Rijnstate Hospital, Arnhem, the Netherlands.
⁸ Department of Gastroenterology and Hepatology, AGEM Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
⁹ Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands.
¹⁰ Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Gastroenterology, Erasmus Medical Center, Rotterdam, the Netherlands.
¹¹ Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, the Netherlands; Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada.

PMID: 36572110
DOI: 10.1016/j.cgh.2022.12.010

Abstract

Background and aims: Although colorectal cancer (CRC) surveillance is embedded in clinical inflammatory bowel disease (IBD) practice, a subset of patients still develops advanced neoplasia (AN) (high-grade dysplasia [HGD] and/or CRC). We aimed to assess the impact of surveillance quality on AN risk in IBD.

Methods: In this multicenter case-control study, we searched the Dutch nationwide pathology databank to identify IBD cases with AN and controls with indefinite or low-grade dysplasia. The surveillance colonoscopy preceding the index lesion (first indefinite for dysplasia [IND]/low-grade dysplasia [LGD] or AN) was used to assess the impact of surveillance quality. We assessed intervals, bowel preparation, cecal intubation, and absence of inflammation as primary quality indicators. In addition, we assessed chromoendoscopy, endoscopist expertise, hospital setting, and biopsy strategy. Associations of quality indicators with AN risk were determined with multivariable logistic regression analyses with Firth's correction.

Results: We included 137 cases and 138 controls. Delayed intervals (58.2% vs 39.6%) and active inflammation (65.3% vs 41.8%) were frequently present in cases and controls and were associated with AN (delayed interval: adjusted odds ratio [aOR], 2.00; 95% confidence interval [CI], 1.07-3.81; P = .03; active inflammation: aOR, 2.46; 95% CI, 1.33-4.61; P < .01). Surveillance compliant with primary quality indicators was associated with a reduced AN risk (aOR, 0.43; 95% CI, 0.22-0.91; P = .03), similar to chromoendoscopy (OR, 0.11; 95% CI, 0.01-0.89; P = .01). Other indicators were not significantly associated with AN.

Conclusions: Surveillance compliant with primary quality indicators is associated with a reduced colitis-associated AN risk. Delayed surveillance intervals and active inflammation were associated with an increased AN risk. This underlines the importance of procedural quality, including endoscopic remission to optimize the effectiveness of endoscopic surveillance.

Keywords: Colitis; Colon; Crohn’s; Dysplasia; Screening.

Publication types

Multicenter Study

MeSH terms

Case-Control Studies
Cecum
Colitis* / pathology
Colitis, Ulcerative* / pathology
Colonic Neoplasms* / pathology
Colonoscopy
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / epidemiology
Colorectal Neoplasms* / etiology
Humans
Hyperplasia / pathology
Inflammation / pathology
Inflammatory Bowel Diseases* / complications