Patients with inflammatory bowel disease who have recurrent low-grade dysplasia on follow-up colonoscopy are at increased risk for advanced neoplasia, according to study results.
Michiel E. de Jong, MD, of the Inflammatory Bowel Disease Centre at Radboud University Medical center in the Netherlands, and colleagues wrote that patients with IBD are already considered at high risk for advanced neoplasia, but data on the proper screening strategy for these patients are unclear.
“It is unclear whether subsequent colonoscopies without recurrent or persistent neoplasia puts the patient in a lower-risk category,” they wrote. “This is of major importance because frequent surveillance colonoscopies put a high burden on IBD patients and have a major impact on endoscopy capacity.”
Researchers analyzed data from the Dutch National Pathology Registry to determine if recurrent low-grade dysplasia (LGD) is a risk factor for advanced neoplasia and to assess the impact of a neoplasia-free period after initial LGD diagnosis on advanced neoplasia risk. They identified all patients with IBD and LGD who had at least one follow-up colonoscopy between 1991 and 2010 (n = 4,284; median follow-up 6.4 years).
Investigators determined that recurrent LGD was a risk factor for advanced neoplasia with an incidence rate of 22.7 per 1,000 patient-years vs. 14 per 1,000 patient-years for no LGD (HR = 1.66; 95% CI, 1.22–2.25).
Additionally, they found that a neoplasia-free follow-up period of 3 years after initial LGD diagnosis was associated with reduced risk for advanced neoplasia (incidence rate 8.5 per 1,000 patient-years).
“Our results support current surveillance guidelines recommending yearly surveillance colonoscopy after the detection of LGD in IBD patients,” de Jong and colleagues wrote. “However, our findings suggest that subsequent lengthening of the surveillance intervals could be considered in selected low-risk patients who remain neoplasia free in the subsequent 3 years after LGD.” – by Alex Young
Disclosure: The authors report no relevant financial disclosures.