- 作者：Robert J. Basseri ; Benjamin Basseri ; Maria E. Vassilaki ; Gil Y. Melmed ; Andrew Ippoliti ; Eric A. Vasiliauskas ; Philip R. Fleshner ; Juan Lechago ; Bing Hu ; Dror Berel ; Stephan R. Targan ; Konstantinos A. Papadakis
- 关键词：Inflammatory bowel disease (IBD) ; Crohn's disease ; Colorectal cancer ; Dysplasia ; Surveillance ; Screening
- 刊名：Journal of Crohn's and Colitis
- 出版年：2012
- 出版时间：September, 2012
- 年：2012
- 卷：6
- 期：8
- 页码：824-829
- 全文大小：372 K
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 ¡À 0.8 years in those with normal examinations, compared to 17.7¡À2.7 years (p < 0.001) in those with HGD, 36.85 ¡À 1.43 in those with LGD (p = 0.021) and 28.32 ¡À 3.24 years in those with any dysplasia/cancer (p = 0.034). Disease duration in patients with normal examinations was 19.1 ¡À 0.5 years, compared to 36.8¡À4.4 years (p < 0.001) in HGD, 16.88 ¡À 2.59 in those with LGD (p = 0.253) and 30.68 ¡À 4.03 years in those with any dysplasia/cancer (p = 0.152). The mean interval between examinations was higher in HGD (31.5 ¡À 9.4 months) compared to those with normal colonoscopies (12.92 ¡À 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.