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

Autor: 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
Přispěvatelé: Gastroenterology & Hepatology, Surgery, Gastroenterology and hepatology, Amsterdam Gastroenterology Endocrinology Metabolism
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: te Groen, M, Derks, M, den Broeder, N, Peters, C, Dijkstra, G, de Vries, A, Romkens, T, Horjus, C, de Boer, N, de Jong, M, Nagtegaal, I, Derikx, L & Hoentjen, F 2023, ' Quality of Surveillance Impacts the Colitis-Associated Advanced Neoplasia Risk : A Multicenter Case-Control Study ', Clinical Gastroenterology and Hepatology . https://doi.org/10.1016/j.cgh.2022.12.010
Clinical Gastroenterology and Hepatology. W.B. Saunders
Clinical Gastroenterology and Hepatology. W.B. Saunders Ltd
ISSN: 1542-3565
Popis: 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.
Databáze: OpenAIRE
Externí odkaz: