期刊
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
卷 20, 期 6, 页码 E1353-E1364出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cgh.2021.08.019
关键词
Colon Cancer; Dysplasia; Inflammatory Bowel Disease; Surveillance
资金
- National Institutes of Health
- Crohn's and Colitis Foundation
- Chleck Family Foundation
- Crohn's and Colitis Foundation [568375]
Continued endoscopic surveillance may have a low yield in patients aged 75 or above with long-standing UC who do not have prior dysplasia.
BACKGROUND & AIMS: Although colonoscopies for dysplasia surveillance are standard of care in patients with long-standing ulcerative colitis (UC), there is a paucity of data on the yield of surveillance colonoscopies in those older than 75 years of age. METHODS: We conducted a multicenter retrospective cohort study including patients with UC who underwent >= 1 colonoscopy at age >= 75 years. The primary outcome was diagnosis of dysplasia (visible or random) and colorectal cancer. Multivariable regression adjusted for relevant confounders examined the predictors of polypoid or non-polypoid dysplasia or colorectal cancer. RESULTS: The primary cohort included 211 patients with UC who underwent 635 colonoscopies after age >= 75 years. A total of 83 patients (39.3%) patients had dysplasia or cancer detected. Among colonoscopies, 123 (19.4%) identified visible dysplasia, 23 (3.6%) had random dysplasia (1 high-grade dysplasia found in each group, respectively), and 5 (0.8%) had colon cancer. In multivariable analysis, prior adenoma or colon cancer below age 75 tears (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.07-3.96), flat dysplasia before 75 years (OR, 2.78; 95% CI, 1.05-7.44), and older age (80-84 years (OR, 2.29; 95% CI, 1.20-4.38), >= 85 years (OR, 3.54; 95% CI, 1.27-9.82) were associated with detection of dysplasia or cancer. Only 1 patient was noted to have a procedure-related complication. CONCLUSIONS: Patients with long-standing UC without prior dysplasia may have a low yield on continued endoscopic surveillance at age >= 75 years. A targeted approach to surveillance may be appropriate in older individuals with UC.
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