Consecutive negative findings on colonoscopy during surveillance predict a low risk of advanced neoplasia in patients with inflammatory bowel disease with long-standing colitis: results of a 15-year multicentre, multinational cohort study.

Autor:	Ten Hove JR; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands., Shah SC; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA.; Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Shaffer SR; IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada., Bernstein CN; IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada., Castaneda D; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA., Palmela C; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA., Mooiweer E; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands., Elman J; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA., Kumar A; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA., Glass J; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA., Axelrad J; Division of Gastroenterology, Columbia University, New York, USA., Ullman TA; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA., Colombel JF; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA., Torres J; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA.; Surgical Department, Gastroenterology Division, Hospital Beatriz Angelo, Loures, Lisboa, Portugal., van Bodegraven AA; Department of Gastroenterology and Hepatology, Vrije Universiteit Medical Center Amsterdam, Amsterdam, The Netherlands.; Dutch Initiative on Crohn and Colitis (ICC), The Netherlands., Hoentjen F; Dutch Initiative on Crohn and Colitis (ICC), The Netherlands.; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands., Jansen JM; Dutch Initiative on Crohn and Colitis (ICC), The Netherlands.; Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis Amsterdam, Amsterdam, The Netherlands., de Jong ME; Dutch Initiative on Crohn and Colitis (ICC), The Netherlands.; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands., Mahmmod N; Dutch Initiative on Crohn and Colitis (ICC), The Netherlands.; Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands., van der Meulen-de Jong AE; Dutch Initiative on Crohn and Colitis (ICC), The Netherlands.; Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands., Ponsioen CY; Dutch Initiative on Crohn and Colitis (ICC), The Netherlands.; Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, Netherlands., van der Woude CJ; Dutch Initiative on Crohn and Colitis (ICC), The Netherlands.; Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands., Itzkowitz SH; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA., Oldenburg B; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.; Dutch Initiative on Crohn and Colitis (ICC), The Netherlands.
Jazyk:	angličtina
Zdroj:	Gut [Gut] 2019 Apr; Vol. 68 (4), pp. 615-622. Date of Electronic Publication: 2018 May 02.
DOI:	10.1136/gutjnl-2017-315440
Abstrakt:	Objectives: Surveillance colonoscopy is thought to prevent colorectal cancer (CRC) in patients with long-standing colonic IBD, but data regarding the frequency of surveillance and the findings thereof are lacking. Our aim was to determine whether consecutive negative surveillance colonoscopies adequately predict low neoplastic risk. Design: A multicentre, multinational database of patients with long-standing IBD colitis without high-risk features and undergoing regular CRC surveillance was constructed. A 'negative' surveillance colonoscopy was predefined as a technically adequate procedure having no postinflammatory polyps, no strictures, no endoscopic disease activity and no evidence of neoplasia; a 'positive' colonoscopy was a technically adequate procedure that included at least one of these criteria. The primary endpoint was advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia or CRC. Results: Of 775 patients with long-standing IBD colitis, 44% (n=340) had > 1 negative colonoscopy. Patients with consecutive negative surveillance colonoscopies were compared with those who had at least one positive colonoscopy. Both groups had similar demographics, disease-related characteristics, number of surveillance colonoscopies and time intervals between colonoscopies. No aCRN occurred in those with consecutive negative surveillance, compared with an incidence rate of 0.29 to 0.76/100 patient-years (P=0.02) in those having > 1 positive colonoscopy on follow-up of 6.1 (P25-P75: 4.6-8.2) years after the index procedure. Conclusion: Within this large surveillance cohort of patients with colonic IBD and no additional high-risk features, having two consecutive negative colonoscopies predicted a very low risk of aCRN occurrence on follow-up. Our findings suggest that longer surveillance intervals in this selected population may be safe. Competing Interests: Competing interests: None declared. (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Databáze:	MEDLINE
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