University of Connecticut Health Center Hartford, CT
Ruchir Damjibhai. Paladiya, MBBS1, Rahul Karna, MD2, Lyubov Tiegs, MD3, Muhammad Ali Butt, MD4, Priyadarshini Loganathan, MD5, Nicole Theis-Mahon, 3, Haleh Vaziri, MD6, Mohammad Bilal, MD7, Gursimran S. Kochhar, MD, FACG8 1University of Connecticut Health Center, Hartford, CT; 2University of Minnesota Medical Center, Minneapolis, MN; 3University of Minnesota, Minneapolis, MN; 4Allegheny General Hospital, Pittsburgh, PA; 5UT Health, San Antonio, TX; 6University of Connecticut Health Center, Farmington, CT; 7University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN; 8Allegheny Health Network, Pittsburgh, PA
Introduction: Patients with inflammatory bowel disease (IBD) are 2-5 times at higher risk of developing colorectal cancer (CRC) and are recommended to undergo dysplasia surveillance for early identification of precancerous lesions. Although the incidence of CRC in IBD patients has declined in recent years, the risk is still higher compared to the general population. We conducted this systematic review and meta-analysis to evaluate the adherence to colonoscopy surveillance guidelines in patients with IBD.
Methods: We conducted a comprehensive search of Ovid Medline, Ovid Embase, Cochrane Central, Scopus, and Web of Science (inception to April 2024) to identify the studies reporting guideline-recommended colonoscopy surveillance adherence rates among patients with IBD. Our primary outcome was adherence to the first surveillance colonoscopy. Secondary outcomes were time to first surveillance procedure, adherence to all surveillance colonoscopies, and use of chromoendoscopy. We also evaluated dysplasia and cancer detected in all procedures. A meta-analysis of proportions was done for all primary and secondary outcomes.
Results: Out of 592 citations, a total of 8 studies were included. Study population consisted of 2588 patients; mean age 46.37 ± 12.08 years with 50.65% females. The various societal guidelines used in the study are reported in Figure 1.
Adherence to first surveillance colonoscopy was demonstrated in 73% (CI: 60 - 83.0%; I² 96%) with median time to first surveillance procedure being 8.3 years (6.9 - 9.6 years; I² 95%). Adherence to all surveillance procedures was seen in 53% (CI: 30 - 74.0%; I² 98%), with chromoendoscopy performed in only 15% (6 - 29%, I² 97%). The colonoscopy findings detected active inflammation in 18% (7 - 38%, I² 97%), dysplasia in 5% (4 - 8%, I² 71%), and cancer in 0.7% (0.4 - 1%, I² 0%). No surveillance was performed in 21% (7 - 51%, I² 97%). Notably, there were no North American Studies assessing adherence to surveillance colonoscopy guidelines in IBD patients.
Discussion: Our analysis has identified the need for improvement in adherence to colonoscopy surveillance guidelines in the IBD patient population. Root cause analysis of non-adherence should be performed to develop strategies to improve guideline adherence in these patients and in turn reduce CRC incidence in IBD patients.
Figure: Figure 1: Distribution of guidelines followed in included studies.
Disclosures:
Ruchir Paladiya indicated no relevant financial relationships.
Rahul Karna indicated no relevant financial relationships.
Lyubov Tiegs indicated no relevant financial relationships.
Muhammad Ali Butt indicated no relevant financial relationships.
Priyadarshini Loganathan indicated no relevant financial relationships.
Nicole Theis-Mahon indicated no relevant financial relationships.
Haleh Vaziri indicated no relevant financial relationships.
Mohammad Bilal: Boston Scientific – Consultant. Cook endoscopy – Speakers Bureau.
Gursimran Kochhar indicated no relevant financial relationships.
Ruchir Damjibhai. Paladiya, MBBS1, Rahul Karna, MD2, Lyubov Tiegs, MD3, Muhammad Ali Butt, MD4, Priyadarshini Loganathan, MD5, Nicole Theis-Mahon, 3, Haleh Vaziri, MD6, Mohammad Bilal, MD7, Gursimran S. Kochhar, MD, FACG8. P4389 - Adherence to Colonoscopy Surveillance Guidelines for Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis., ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
