Adjustment of Surveillance Intervals for Ulcerative Colitis-Associated Neoplasia Based on Disease Duration

The risk of colitis-associated cancer increases with disease duration in ulcerative colitis (UC), yet surveillance colonoscopy protocols generally stratify risk uniformly for patients with disease lasting over 8 years. This study evaluated whether shorter surveillance intervals might enhance lesion detection rates in patients with extended disease duration.

This retrospective observational study analyzed patients diagnosed with UC-associated neoplasms between 2010 and 2023. Colonoscopies before lesion detection were retrospectively reviewed, and risk stratification was applied according to four established guidelines. The recommended surveillance intervals were recalculated based on the stratified risk, and lesion detection rates were compared across increasing risk categories for specific disease duration.

A total of 39 patients were included, with a median disease duration of 21 years (14-27), and a median colonoscopy interval of 1.3 years (1.1-2.2). Lesion detection rates were 72%, 59%, 44%, and 56% for American Society for Gastrointestinal Endoscopy (ASGE), American Gastroenterological Association (AGA), European Crohn's and Colitis Organisation (ECCO), and British Society of Gastroenterology (BSG) guidelines, respectively. Adjusting risk stratification upward by one rank for disease durations of ≥ 15, ≥ 20, ≥ 25, and ≥ 30 years resulted in increased detection rates: 90%, 87%, 82%, and 72% for ASGE; 85%, 82%, 74%, and 64% for AGA; 82%, 74%, 62%, and 49% for ECCO; and 82%, 79%, 72%, and 62% for BSG, respectively. The longest period with a significant difference in detection rates was observed in patients with disease durations of 20-25 years.

For patients with long-standing UC, reducing surveillance intervals may improve the detection of colitis-associated neoplasia, with a practical focus on those with 20-25 years of disease duration.