| Original Article |
Questions: 1) What is the yield of surveillance colonoscopies in patients with ulcerative colitis (UC) aged 75 years or older? 2) What are the risk factors for dysplasia or colorectal cancer (CRC) in older adults with UC?
Design/Method: A multicenter retrospective cohort study was conducted. The primary outcome was a diagnosis of dysplasia and colorectal cancer. Multivariable regression was adjusted for relevant confounders and examining the predictors of polypoid or non-polypoid dysplasia or colorectal cancer
Setting: The United States
Patients/Study community: Patients with UC who underwent ≥1 colonoscopy at age ≥75 years
Results: Individuals with long-standing UC without a prior history of dysplasia on surveillance colonoscopies may have a lower yield on continued endoscopic surveillance at or above the age of 75 years
| Characteristics of all surveillance colonoscopies performed on patients with UC Age ≥75 Years, stratified by those with dysplasia or cancer | |||
| Characteristic | Dysplasia or cancer (n = 141), n (%) | No dysplasia or cancer (n =494), n (%) | P value |
| Mean age (SD), y
· 75-79 · 80-84 · 85-89 |
79.2 (3.4)
83 (58.9) 44 (31.2) 14 (9.9) |
78.7 (3.2)
332 (67.2) 130 (26.3) 32 (6.5) |
.14
.14 |
| Sex (male) | 83 (58.8) | 292 (59.1) | .96 |
| Disease duration, y
· 8-20 · >20 |
53 (37.6) 88 (62.4) |
171 (34.6) 322 (65.2) |
.71 |
| Disease phenotype Proctitis
· Left-sided · Pancolitis |
48 (34.0) 92 (65.3) |
183 (37.0) 311 (63.0) |
.57 |
| Ever 5-ASA (Aminosalicylates) | 134 (95.0) | 465 (94.1) | .68 |
| Ever immunomodulators | 37 (26.2) | 143 (29.0) | .53 |
| Ever biologics | 15 (10.6) | 109 (22.1 | <.03 |
| Ever Smoker | 88 (62.4) | 326 (66.0) | .43 |
| Primary sclerosing cholangitis (PSC) | 3 (2.1) | 23 (4.7) | .18 |
| Prior malignancy | 66 (46.8) | 224 (45.3) | .76 |
| First degree relative with history of colon cancer | 16 (11.4) | 52 (10.5) | .78 |
| Prior adenoma or colon cancer age <75y | 63 (44.7) | 115 (23.3) | <.01 |
| Prior flat dysplasia age <75 y | 28 (19.9) | 74 (15.0) | .16 |
| Procedure characteristics Preparation quality
· Poor · Good · Excellent Mayo endoscopic score · Inactive · Active |
4 (2.8) 105 (74.5) 32 (22.7)
123 (87.2) 18 (12.8) |
20 (4.0) 342 (69.2) 132 (26.7)
398 (80.6) 96 (19.4) |
.46
.07 |
| 5-ASA: Aminosalicylates, PSC: primary sclerosing cholangitis, SD: standard deviation | |||
Commentary:
| These findings show that around the age of 75, people without a history of dysplasia may yield less during endoscopic surveillance. Therefore, it is sagely acceptable to use a tailored approach that takes into account factors including age, comorbidities, life expectancy, and history of dysplasia, as well as adherence to prior surveillance exams, to assess whether CRC screening should continue in patients with chronic IBD. |
Citation: Alexa N. Sasson, Gabriel Sheehan, Amy Yu, and et all. Yield and predictors of surveillance colonoscopies in older adults with long-standing ulcerative colitis. Clinical Gastroenterology and Hepatology. 2022; 20(6): 1353-1364
DOI: 10.1016/j.cgh.2021.08.019.
https://pubmed.ncbi.nlm.nih.gov/34425278/
Topics: Colon Cancer, Dysplasia, Inflammatory Bowel Disease, Surveillance
