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Colonoscopy; Surveillance Indications

Colonoscopy; Surveillance Indications. SR Brown Colorectal Surgeon Sheffield Teaching Hospitals. Colorectal cancer screening in high risk groups. Gut 2002;51(Suppl V). Screening vs Surveillance. Screening Asymptomatic population Surveillance Previous symptoms/high risk. High risk groups.

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Colonoscopy; Surveillance Indications

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  1. Colonoscopy; Surveillance Indications SR Brown Colorectal Surgeon Sheffield Teaching Hospitals

  2. Colorectal cancer screening in high risk groups Gut 2002;51(Suppl V)

  3. Screening vs Surveillance • Screening • Asymptomatic population • Surveillance • Previous symptoms/high risk

  4. High risk groups • Previous colorectal cancer • Acromegaly • Ureterosigmoidostomy • Hereditary and Familial bowel cancer • IBD • Previous polyps

  5. Aims • To discuss salient aspects of guidelines • To highlight recent developments in colonoscopic surveillance

  6. Colorectal cancer surveillance

  7. Colorectal cancer surveillance; aims • Detect recurrence • Diagnose and treat metachronous neoplasia • Evaluate anastomosis

  8. Colorectal cancer surveillance • ‘Incidence metachronous tumours 5-10%’ • Metachronous cancers • approx. 2% • Cochrane review 1.3% (18/1342) • Metachronous adenomas • 22% (425/1923)

  9. Colorectal cancer surveillance • Synchronous/‘early’ metachronous cancers • 4% • 0.6% ‘missed’ due to incomplete colon exam

  10. Familial cancer surveillance

  11. Familial Cancer Summary

  12. Lifetime risk of colorectal cancer Houlston et al. 1970

  13. Familial Cancer Summary

  14. Chances of preventing death with screening colonoscopy35 year old with FDR<45 years • 1 in 25,000 people aged 30-39 develop colorectal cancer per year • Relative risk = 5 • Risk of cancer = 1 in 5000 in per year • Assume asymptomatic cancer dwell time of 3 years • Chance of detecting cancer 1 in 1660

  15. Familial Cancer Summary

  16. Chances of preventing death with screening colonoscopy55 year old with FDR<45 years • 1 in 1,630 people aged 50-59 develop colorectal cancer per year • Relative risk = 3 • Risk of cancer = 1 in 543 per year • Assume asymptomatic cancer dwell time of 3 years • Chance of detecting cancer 1 in 181

  17. Hereditary cancer surveillance

  18. Hereditary Cancer Summary

  19. IBD surveillance

  20. IBD Summary

  21. Controversies • ? Survival advantage (Cochrane review 2004) • No clear evidence • May allow earlier detection of cancer • ?lead-time bias

  22. Controversies • Ongoing inflammation increases risk • Dysplasia as a marker for cancer • Reliability • Detection • Histological interpretation

  23. Controversies;detection • Pan-chromoscopy and targeted biopsy (Rutter 2004) • Back-to-back colonoscopy • Conventional then dye-spray • Conventional no dysplasia in 2904 random biopsies • Targeted 157 biopsies 7 patients with dysplasia

  24. Ileo-anal pouch surveillance

  25. Pouch cancer • 15 case reports • 10 residual rectal mucosa • 5 ??pouch mucosa • All pre-existing dysplasia • 8 had cancer in original resection • 9 had mucosectomy

  26. Surveillance recommendations • Pouchoscopy • 1st year then 2-3 yearly • Increased surveillance (yearly) if • Pre-existing dysplasia/cancer • PSC • Mucosectomy if high risk

  27. Polyp surveillance

  28. Summary • Read guidelines!!

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