Screening and surveillance colonoscopy in chronic Crohn's colitis

Background & Aims: Unlike ulcerative colitis, there are few reports on the efficacy of surveillance colonoscopy in patients with chronic Crohn's colit is and therefore little agreement as to whether routine surveillance is ind icated. We report on 259 patients with chronic Crohn's colitis who underwen t screening and subsequent surveillance colonoscopy and biopsy since 1980, Methods: Biopsies were performed at 10-cm intervals and from strictures and polypoid masses. Pathology was classified as normal, dysplasia (indefinite , low-grade, high-grade), or carcinoma, Results: A total of 663 examination s were performed on 259 patients. The median interval between examinations was 24 months; examinations were performed more frequently (1-6 months) in patients with dysplasia on biopsy. A thinner-caliber colonoscope was requir ed to complete 12% of screening examinations and 23% of surveillance examin ations, The pediatric colonoscope helped increase our yield of neoplasia by 19%. The screening and surveillance program detected dysplasia or cancer i n 16% (10 indefinite, 23 low-grade, and 4 high-grade dysplasias and 5 cance rs). A finding of definite dysplasia or cancer was associated with age >45 years and increased symptoms, By life table analysis, the probability of de tecting dysplasia or cancer after a negative screening colonoscopy was 22% by the fourth surveillance examination, Conclusions: Colonoscopic surveilla nce should be strongly considered in chronic extensive Crohn's colitis.