title: Colorectal cancer screening and surveillance in Crohn's colitis.
abstract: OBJECTIVE
  To assess colonoscopic screening and surveillance for detecting neoplasia in patients with long-standing colonic Crohn's disease (CD).
  
  
  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±0.8 years in those with normal examinations, compared to 17.7±2.7 years (p<0.001) in those with HGD, 36.85±1.43 in those with LGD (p=0.021) and 28.32±3.24 years in those with any dysplasia/cancer (p=0.034). Disease duration in patients with normal examinations was 19.1±0.5 years, compared to 36.8±4.4 years (p<0.001) in HGD, 16.88±2.59 in those with LGD (p=0.253) and 30.68±4.03 years in those with any dysplasia/cancer (p=0.152). The mean interval between examinations was higher in HGD (31.5±9.4 months) compared to those with normal colonoscopies (12.92±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.
authors.affiliation: Department of Medicine and Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Basseri
authors.forename: Benjamin
authors.initials: B
authors.lastname: Basseri
authors.forename: Maria E
authors.initials: ME
authors.lastname: Vassilaki
authors.forename: Gil Y
authors.initials: GY
authors.lastname: Melmed
authors.forename: Andrew
authors.initials: A
authors.lastname: Ippoliti
authors.forename: Eric A
authors.initials: EA
authors.lastname: Vasiliauskas
authors.forename: Philip R
authors.initials: PR
authors.lastname: Fleshner
authors.forename: Juan
authors.initials: J
authors.lastname: Lechago
authors.forename: Bing
authors.initials: B
authors.lastname: Hu
authors.forename: Dror
authors.initials: D
authors.lastname: Berel
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Targan
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Papadakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D001005:Anus Neoplasms / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control; D003424:Crohn Disease / Q000150:complications*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control; D012307:Risk Factors; D055815:Young Adult