Colorectal cancer screening and surveillance in Crohn's colitis

Aims: To assess colonoscopic screening and surveillance for detecting neoplasia in patients with long-standing colonic Crohn's disease (CD). Patients and Methods: Colonoscopy and biopsy records from patients with colonic CD were evaluated at the Cedars-Sinai Inflammatory Bowel Disease Center during a 17-year period (1992-2009). Results: Overall, 904 screening and surveillance examinations were performed on 411 patients with Crohn's colitis (mean 2.2 examinations per patient). The screening and surveillance examinations detected neoplasia in 5.6% of the patient population; 2.7% had low-grade dysplasia (LGD) (n = 11), 0.7% had high-grade dysplasia (HGD) (n = 3), and 2.2% had carcinoma (anal carcinoma n = 3; rectal carcinoma n = 6). Mean age of CD diagnosis was 25.6 ± 0.8 years in those with normal examinations, compared to 17.7±2.7 years (p < 0.001) in those with HGD, 36.85 ± 1.43 in those with LGD (p = 0.021) and 28.32 ± 3.24 years in those with any dysplasia/cancer (p = 0.034). Disease duration in patients with normal examinations was 19.1 ± 0.5 years, compared to 36.8±4.4 years (p < 0.001) in HGD, 16.88 ± 2.59 in those with LGD (p = 0.253) and 30.68 ± 4.03 years in those with any dysplasia/cancer (p = 0.152). The mean interval between examinations was higher in HGD (31.5 ± 9.4 months) compared to those with normal colonoscopies (12.92 ± 1.250 months; p = 0.002). Conclusions: We detected cancer or dysplasia in 5.6% of patients with long-standing Crohn's colitis enrolled in a screening and surveillance program. Younger age at diagnosis of CD, longer disease course, and greater interval between exams were risk factors for the development of dysplasia.