Frequency and impact of repeat colonoscopy as a treat-to-target approach in pediatric inflammatory bowel disease

Endoscopic healing (EH) is a treatment target in inflammatory bowel disease (IBD). However, adherence to repeat colonoscopy (RC) for EH assessment in pediatrics remains variable. We aimed to evaluate the frequency and timing of RC after diagnosis and its impact on treatment decisions at a large pediatric IBD center.

We conducted a retrospective cohort study of pediatric patients diagnosed with IBD January 2019 to December 2021 using an internal patient database and electronic medical records. Data included demographics, treatments, timing of RC, reasons for no RC (if not completed), and therapy modifications following RC (medication escalations and de-escalations). The study took place within the context of an institutional quality improvement project aimed at improving RC rates within 15 months of diagnosis.

Of 325 patients diagnosed via baseline colonoscopy during the study interval, 91% underwent RC; 8% within 6 months due to inadequate primary therapy response, 67% between 7 and 15 months, and 16% beyond 15 months. Among the 272 patients with a RC > 6 months postdiagnosis, therapy modification occurred in 39% (107/272), with 81% (87/107) requiring medication escalation, 16% (17/107) medication de-escalation, and 3% (3/107) surgical intervention. Only 3% of patients declined a RC due to patient/family preference.

Adherence to the treat-to-target strategy recommending RC within 15 months of diagnosis was high, exceeding previously reported pediatric rates. Only 3% of patients/families declined RC despite this being a perceived barrier toward assessment of EH. Therapy adjustments post-RC were frequent, underscoring the importance of mucosal assessment in guiding treatment optimization.