title: Endoscopic Detection of Small Bowel Dysplasia and Adenocarcinoma in Crohn's Disease: A Prospective Cohort-Study in High-Risk Patients.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France marion.simon3@free.fr.|Hepato-Gastroenterology Department, Saint-Louis Hospital, Paris VII University, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Simon
authors.affiliation: Hepato-Gastroenterology Department, Saint-Antoine Hospital, Paris VI University, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Cosnes
authors.affiliation: Hepato-Gastroenterology Department, Saint-Louis Hospital, Paris VII University, Paris, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Gornet
authors.affiliation: Hepato-Gastroenterology Department, Saint-Antoine Hospital, Paris VI University, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Seksik
authors.affiliation: Hepato-Gastroenterology Department, Beaujon Hospital, Paris VII University, Clichy, France.
authors.forename: C
authors.initials: C
authors.lastname: Stefanescu
authors.affiliation: Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Blain
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez hospital, University of Lille 2, Lille, France.|Inserm Unit 995, Université Lille 2, Lille, France.
authors.forename: B
authors.initials: B
authors.lastname: Pariente
authors.affiliation: Hepato-Gastroenterology Department, Lyon Sud Hospital, Pierre-Bénite, France.
authors.forename: S
authors.initials: S
authors.lastname: Nancey
authors.affiliation: Gastroenterology Department, University Hospital of Besançon, Besançon, France.
authors.forename: L
authors.initials: L
authors.lastname: Vuitton
authors.affiliation: Hepato-Gastroenterology Department, Claude Huriez hospital, University of Lille 2, Lille, France.|Gastroenterology Department, University Hospital of Besançon, Besançon, France.
authors.forename: M
authors.initials: M
authors.lastname: Nachury
authors.affiliation: Inflammatory Bowel Disease Centre Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: D'Haens
authors.affiliation: Hepato-Gastroenterology Department, University Hospital of Nice, Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Filippi
authors.affiliation: Biostatistics Department, Saint-Louis Hospital, Paris VII University, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Chevret
authors.affiliation: Hepato-Gastroenterology Department, Haut-Leveque Hospital, University of Bordeaux II, Pessac, France.
authors.forename: D
authors.initials: D
authors.lastname: Laharie
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: Crohn’s disease; Small bowel adenocarcinoma; endoscopic screening