Research published in Gut showed that patients with inflammatory bowel disease and no additional high-risk factors who had consecutive negative colonoscopies carried a very low risk for developing advanced colorectal neoplasia.
Bas Oldenburg, MD, of the department of gastroenterology and hepatology at University Medical Center Utrecht and the Dutch Initiative on Crohn and Colitis, in the Netherlands, and colleagues wrote that their findings could justify longer surveillance intervals for low-risk patients.
“While patients with IBD colitis are considered to carry a higher-than-average CRC risk ... the appropriateness of the recommended intervals of colonoscopic surveillance in this population has been incompletely investigated,” they wrote. “Considering that the overall risk of CRC in IBD is decreasing over time and the sensitivity for detecting dysplasia is increasing due in part to technological advancements in neoplasia detection, if surveillance is maintained at overly frequent intervals in all patients with IBD, IBD surveillance programs are at risk of becoming high-intensity/low-value cancer prevention strategies.”
Oldenburg and colleagues constructed a multicenter, multinational database of patients with long-standing IBD colitis without high-risk features who are undergoing regular CRC surveillance. They defined a colonoscopy as “negative” if it found no post-inflammatory polyps, strictures, endoscopic disease activity or evidence of neoplasia. The primary endpoint of the study was advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia or CRC.
Overall, 340 of the 775 patients in the database had at least one negative colonoscopy (44%).
When they looked at patients who had consecutive negative surveillance colonoscopies, Oldenburg and colleagues found no incidence of aCRN, compared with an incidence rate of 0.29 to 0.76 per 100 patient-years in the group that had at least one negative colonoscopy (P = .02).
The investigators wrote that the findings suggest that a surveillance interval of longer than two years, and up to five years, might be appropriate for patients who have consecutive negative colonoscopies. The long intervals could optimize the cost and resource-to-benefit ratio of surveillance, as well as improve patients’ quality of life, they wrote.
“We identified that in a selected low-risk group, having two consecutive negative surveillance examinations predicts a very low and potentially negligible risk of aCRN on continued follow-up,” they wrote. “While we believe these patients can be safely surveyed at a five-year interval, the robustness of this recommendation would need to be tested in further longitudinal research.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.