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149 COLORECTAL SURVEILLANCE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE C Williams, R Panaccione, P Beck It is well known that patients with ulcerative colitis and Crohn's disease are at increased risk for colorectal cancer. However, it has been proposed that this increased incidence is not seen locally in Calgary. This either reflects a truly decreased regional incidence of colorectal cancer in the IBD patient population or a decreased identification of cases. Nonadherence to established surveillance colonoscopy guidelines may contribute to missed cases. Guidelines emphasize the importance of obtaining adequate tissue biopsies (two to four specimens per every 10 cm of bowel). Insufficient numbers of biopsies can lead to missed diagnoses.
University of Calgary, Calgary, Alberta
The aim of this study was to assess whether adequate numbers of biopsies are obtained during surveillance colonoscopy in IBD patients.
The Endopro database was used to identify all surveillance colonoscopy exams of IBD patients performed at the Foothills Medical Center, Calgary, Alberta in the year 2004. Cases involving patients who had previous bowel resections were omitted. Through chart review, the average number of biopsy specimens per exam in patients with ulcerative colitis and Crohn's disease was calculated. Biopsy results (positive or negative for dysplasia) were also recorded.
The Endopro database identified 90 cases. Four cases were not surveillance studies. Four cases involved Crohn's disease patients who had previous bowel resections. One case involved a patient who did not have IBD. The remaining 81 cases were analyzed. Fifteen patients had with Crohn's disease and 66 had ulcerative colitis. Two hundred fifty-two biopsies were obtained from the Crohn's disease patients (average of 16.8 and median of 13.5 biopsies per colonoscopy). One thousand two hundred eighty-one biopsies were obtained from the patients with ulcerative colitis (average of 19.4 and median of 20 biopsies per colonoscopy). No dysplasia was found.
The average colon is approximately 80 cm in length. According to current surveillance guidelines in patients with IBD, 16 to 32 biopsy specimens should be obtained during each colonoscopy. While the average number of biopsies per exam was above the recommended lower limit in this study group, many surveillance colonoscopies lack adequate numbers of biopsy samples.