M Simon1,2, J Cosnes3, J M Gornet2, P Seksik3, C Stefanescu4, A Blain5, B Pariente6,7, S Nancey8, L Vuitton9, M Nachury6,9, G D'Haens10, J Filippi11, S Chevret12, D Laharie13. 1. Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France marion.simon3@free.fr. 2. Hepato-Gastroenterology Department, Saint-Louis Hospital, Paris VII University, Paris, France. 3. Hepato-Gastroenterology Department, Saint-Antoine Hospital, Paris VI University, Paris, France. 4. Hepato-Gastroenterology Department, Beaujon Hospital, Paris VII University, Clichy, France. 5. Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France. 6. Hepato-Gastroenterology Department, Claude Huriez hospital, University of Lille 2, Lille, France. 7. Inserm Unit 995, Université Lille 2, Lille, France. 8. Hepato-Gastroenterology Department, Lyon Sud Hospital, Pierre-Bénite, France. 9. Gastroenterology Department, University Hospital of Besançon, Besançon, France. 10. Inflammatory Bowel Disease Centre Academic Medical Centre, Amsterdam, The Netherlands. 11. Hepato-Gastroenterology Department, University Hospital of Nice, Nice, France. 12. Biostatistics Department, Saint-Louis Hospital, Paris VII University, Paris, France. 13. Hepato-Gastroenterology Department, Haut-Leveque Hospital, University of Bordeaux II, Pessac, France.
Abstract
BACKGROUND AND AIMS: Crohn's disease [CD] is associated with an increased risk of small bowel adenocarcinoma [SBA]. There are no recommendations on endoscopic screening of SBA in CD patients. The aim of this study was to evaluate the feasibility and value of endoscopic screening for SBA in CD patients at high-risk of SBA. METHODS: We performed an exploratory multi-centre study in a prospective cohort of CD patients at high-risk of SBA defined as long-term small bowel disease without bowel resection for the past 10 years. Depending on the location of the disease, baseline upper and/or lower enteroscopies were performed. Random and targeted biopsies using chromoendoscopy were taken. Patients were followed-up for at least 1 year after inclusion. RESULTS: In total, 101 patients [62 men; median age: 48 years; median duration of disease: 19 years] were recruited in ten centres. The endoscopic procedure was incomplete in 47 cases because of impassable strictures and dilation was performed in four patients. Indeterminate small bowel dysplasia was identified in two patients at endoscopic screening; SBA was confirmed in one after surgical resection. With an at least 1-year follow-up duration, two additional cases of SBA were identified in patients who underwent surgery for obstruction, resulting in a 33% sensitivity rate for SBA endoscopic screening. CONCLUSION: In a cohort of high-risk patients, the prevalence of dysplasia and SBA on CD was 4%. Because of its low sensitivity, endoscopic screening cannot be recommended for surveillance in CD patients at high-risk of SBA.
BACKGROUND AND AIMS: Crohn's disease [CD] is associated with an increased risk of small bowel adenocarcinoma [SBA]. There are no recommendations on endoscopic screening of SBA in CDpatients. The aim of this study was to evaluate the feasibility and value of endoscopic screening for SBA in CDpatients at high-risk of SBA. METHODS: We performed an exploratory multi-centre study in a prospective cohort of CDpatients at high-risk of SBA defined as long-term small bowel disease without bowel resection for the past 10 years. Depending on the location of the disease, baseline upper and/or lower enteroscopies were performed. Random and targeted biopsies using chromoendoscopy were taken. Patients were followed-up for at least 1 year after inclusion. RESULTS: In total, 101 patients [62 men; median age: 48 years; median duration of disease: 19 years] were recruited in ten centres. The endoscopic procedure was incomplete in 47 cases because of impassable strictures and dilation was performed in four patients. Indeterminate small bowel dysplasia was identified in two patients at endoscopic screening; SBA was confirmed in one after surgical resection. With an at least 1-year follow-up duration, two additional cases of SBA were identified in patients who underwent surgery for obstruction, resulting in a 33% sensitivity rate for SBA endoscopic screening. CONCLUSION: In a cohort of high-risk patients, the prevalence of dysplasia and SBA on CD was 4%. Because of its low sensitivity, endoscopic screening cannot be recommended for surveillance in CDpatients at high-risk of SBA.