Prevalence of colorectal cancer surveillance for ulcerative colitis in an integrated health care delivery system.
OBJECTIVE
The absence of grade A supporting evidence for surveillance colonoscopy in patients with ulcerative colitis (UC) has led to controversy regarding its benefit, yet it is routinely recommended in practice guidelines. Limited data are available on rates of colonoscopy surveillance and factors associated with surveillance.


METHODS
A retrospective study of UC patients receiving care between 2006 and 2007 with ≥ 8 years history of UC was conducted. Primary outcome was the proportion of patients who underwent surveillance during this 2-year study period. Sociodemographic and disease factors were identified a priori from variables recorded electronically in the medical record; multivariable associations with surveillance were estimated using logistic regression.


RESULTS
Of 771 patients with ≥ 8 years history of UC, 24.6% of patients underwent at least 1 surveillance colonoscopy within the 2-year study period, with a maximum of 38.5% observed among patients with primary sclerosing cholangitis. In a multivariable analysis, gender, age, race, and education were not associated with surveillance. Factors associated with increasing surveillance included lack of significant comorbidity (Charlson-Deyo index 0 vs 1+: odds ratio [OR], 1.7; 95% confidence interval: 1.1-2.5), > 3 inflammatory bowel disease-related outpatient visits (OR, 2.0; 95% CI: 1.4-3.0), and use of mesalamine (OR, 2.8; 95% CI: 1.7-4.4).


CONCLUSIONS
Utilization of surveillance colonoscopy in a 2-year period was low, even among high-risk patients. Although specific factors recorded in computerized data were identified to be associated with surveillance, a greater understanding of how patients and physicians decide on surveillance is needed.
Velayos
Fernando S
FS
Division of Gastroenterology, Department of Internal Medicine, University of California, San Francisco 94115, USA. Fernando.Velayos@ucsf.edu
Liu
Liyan
L
Lewis
James D
JD
Allison
James E
JE
Flowers
Nicole
N
Hutfless
Susan
S
Abramson
Oren
O
Perry
Geraldine S
GS
Herrinton
Lisa J
LJ
D002140:California / Q000453:epidemiology; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies