Advertisement

Digestive Diseases and Sciences

, Volume 62, Issue 12, pp 3586–3593 | Cite as

Nearly a Third of High-Grade Dysplasia and Colorectal Cancer Is Undetected in Patients with Inflammatory Bowel Disease

  • Swathi EluriEmail author
  • Alyssa M. Parian
  • Berkeley N. Limketkai
  • Christina Y. Ha
  • Steven R. Brant
  • Sharon Dudley-Brown
  • Jonathan E. Efron
  • Sandy G. Fang
  • Susan L. Gearhart
  • Michael R. Marohn
  • Stephen J. Meltzer
  • Safar Bashar
  • Brindusa Truta
  • Elizabeth A. Montgomery
  • Mark G. Lazarev
Original Article

Abstract

Background

It is unclear whether intensive surveillance protocols have resulted in a decreased incidence of colorectal cancer (CRC) in inflammatory bowel disease (IBD).

Aims

To determine the prevalence and characteristics of IBD associated high-grade dysplasia (HGD) or CRC that was undetected on prior colonoscopy.

Methods

This is a single-center, retrospective study from 1994 to 2013. All participants had a confirmed IBD diagnosis and underwent a colectomy with either HGD or CRC found in the colectomy specimen.The undetected group had no HGD or CRC on prior colonoscopies. The detected group had HGD or CRC identified on previous biopsies.

Results

Of 70 participants, with ulcerative colitis (UC) (n = 47), Crohn’s disease (CD) (n = 21), and indeterminate colitis (n = 2), 29% (n = 20) had undetected HGD/CRC at colectomy (15 HGD and 5 CRC). In the undetected group, 75% had prior LGD, 15% had indefinite dysplasia, and 10% had no dysplasia (HGD was found in colonic strictures). Patients in the undetected group were more likely to have pancolitis (55 vs. 20%) and multifocal dysplasia (35 vs. 8%). The undetected group was less likely to have CRC at colectomy (25 vs. 62%). There was a trend toward right-sided HGD/CRC at colectomy (40 vs. 20%; p = 0.08). In addition, 84% of the lesions found in the rectum at colectomy were not seen on prior colonoscopy in the undetected group.

Conclusions

The prevalence of previously undetected HGD/CRC in IBD found at colectomy was 29%. The high proportion of undetected rectal and right-sided HGD/CRC suggests that these areas may need greater attention during surveillance.

Keywords

Inflammatory bowel diseases Cancer screening Colorectal neoplasms Colonoscopy 

Notes

Acknowledgments

This study was funded in part by the National Institute for Diabetes and Digestive and Kidney Diseases Grant T32DK07634 and DK190040.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10620_2017_4652_MOESM1_ESM.docx (89 kb)
Supplementary material 1 (DOCX 88 kb)

References

  1. 1.
    Munkholm P. Review article: the incidence and prevalence of colorectal cancer in inflammatory bowel disease. Aliment Pharmacol Ther. 2003;18:1–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Lennard-Jones JE, Morson BC, Ritchie JK, Williams CB. Cancer surveillance in ulcerative colitis. Experience over 15 years. Lancet. 1983;2:149–152.CrossRefPubMedGoogle Scholar
  3. 3.
    Mattar MC, Lough D, Pishvaian MJ, Charabaty A. Current management of inflammatory bowel disease and colorectal cancer. Gastrointest Cancer Res. 2011;4:53–61.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Jess T, Simonsen J, Jorgensen KT, Pedersen BV, Nielsen NM, Frisch M. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology. 2012;143:375.e371–381.e371. (quiz e313–374).CrossRefGoogle Scholar
  5. 5.
    Kappelman MD, Farkas DK, Long MD, et al. Risk of cancer in patients with inflammatory bowel diseases: a nationwide population-based cohort study with 30 years of follow-up evaluation. Clin Gastroenterol Hepatol. 2014;12:265.e261–273.e261.Google Scholar
  6. 6.
    Lakatos PL, Lakatos L. Challenges in calculating the risk for colorectal cancer in patients with ulcerative colitis. Clin Gastroenterol Hepatol. 2012;10:1179. author reply 1179–1180.CrossRefPubMedGoogle Scholar
  7. 7.
    Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut. 2001;48:526–535.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Farraye FA, Odze RD, Eaden J, Itzkowitz SH. AGA technical review on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138:746.e741–774.e741. (quiz e712–743).Google Scholar
  9. 9.
    Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010;59:666–689.CrossRefPubMedGoogle Scholar
  10. 10.
    Herrinton LJ, Liu L, Levin TR, Allison JE, Lewis JD, Velayos F. Incidence and mortality of colorectal adenocarcinoma in persons with inflammatory bowel disease from 1998 to 2010. Gastroenterology. 2012;143:382–389.CrossRefPubMedGoogle Scholar
  11. 11.
    Bernstein CN, Shanahan F, Weinstein WM. Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis? Lancet. 1994;343:71–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Rutter MD, Saunders BP, Wilkinson KH, et al. Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology. 2006;130:1030–1038.CrossRefPubMedGoogle Scholar
  13. 13.
    Wang YR, Cangemi JR, Loftus EV Jr, Picco MF. Rate of early/missed colorectal cancers after colonoscopy in older patients with or without inflammatory bowel disease in the United States. Am J Gastroenterol. 2013;108:444–449.CrossRefPubMedGoogle Scholar
  14. 14.
    Krugliak Cleveland N, Colman RJ, Rodriquez D, et al. Surveillance of IBD using high definition colonoscopes does not miss adenocarcinoma in patients with low-grade dysplasia inflamm. Bowel Dis. 2016;22:631–637.CrossRefGoogle Scholar
  15. 15.
    Lashner BA, Turner BC, Bostwick DG, Frank PH, Hanauer SB. Dysplasia and cancer complicating strictures in ulcerative colitis. Dig Dis Sci. 1990;35:349–352.CrossRefPubMedGoogle Scholar
  16. 16.
    Fumery M, de Chambrun GP, Stefanescu C, et al. Detection of dysplasia or cancer in 3.5% of patients with inflammatory bowel disease and colonic strictures. Clin Gastroenterol Hepatol. 2015;10:1770–1775.CrossRefGoogle Scholar
  17. 17.
    Samadder NJ, Curtin K, Tuohy TM, et al. Characteristics of missed or interval colorectal cancer and patient survival: a population-based study. Gastroenterology. 2014;146:950–960.CrossRefPubMedGoogle Scholar
  18. 18.
    Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Rex DK. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol. 2006;101:2866–2877.CrossRefPubMedGoogle Scholar
  20. 20.
    Pickhardt PJ, Nugent PA, Mysliwiec PA, Choi JR, Schindler WR. Location of adenomas missed by optical colonoscopy. Ann Intern Med. 2004;141:352–359.CrossRefPubMedGoogle Scholar
  21. 21.
    Shergill AK, Conners EE, McQuaid KR, et al. Protective association of colonoscopy against proximal and distal colon cancer and patterns in interval cancer. Gastrointest Endosc. 2015;82:529–537.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Swathi Eluri
    • 1
    • 2
    Email author
  • Alyssa M. Parian
    • 1
  • Berkeley N. Limketkai
    • 3
    • 5
  • Christina Y. Ha
    • 4
    • 6
  • Steven R. Brant
    • 1
  • Sharon Dudley-Brown
    • 1
  • Jonathan E. Efron
    • 1
  • Sandy G. Fang
    • 1
  • Susan L. Gearhart
    • 1
  • Michael R. Marohn
    • 1
  • Stephen J. Meltzer
    • 1
  • Safar Bashar
    • 1
  • Brindusa Truta
    • 1
  • Elizabeth A. Montgomery
    • 1
  • Mark G. Lazarev
    • 1
  1. 1.Division of Gastroenterology and Hepatology, School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Stanford University School of MedicineStanfordUSA
  4. 4.David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA
  5. 5.Digestive Health Liver ClinicPalo AltoUSA
  6. 6.Ronald Reagan UCLA Medical CenterLos AngelesUSA

Personalised recommendations