Sporadic Adenoma Detection During Routine IBD Colonoscopies: A Secondary Analysis of Prospectively Collected Data

Area of Science:

• Gastroenterology
• Endoscopy
• Colorectal Cancer Screening

Background:

• Colonoscopy quality in colorectal cancer (CRC) screening relies on adenoma detection and withdrawal time (WT).
• Inflammatory bowel disease (IBD) surveillance requires complex procedures like targeted biopsies and dysplasia assessment, impacting WT.
• Current CRC screening quality benchmarks, based on non-IBD patients, may not be suitable for IBD patients who have a higher CRC risk.

Purpose of the Study:

• To compare the sporadic adenoma detection rate (ADR) in screening-age IBD patients with endoscopic remission to that of non-IBD patients.
• To investigate the impact of IBD-specific procedural demands on adenoma detection dynamics during colonoscopy.
• To determine if current quality benchmarks for CRC screening are applicable to IBD surveillance.

Main Methods:

• Secondary analysis of prospectively collected colonoscopy data from a tertiary academic center.
• Comparison of ADR between IBD and non-IBD patient groups, adjusting for WT and other confounders.
• Evaluation of secondary outcomes including mean WT, polyp detection rate, and advanced adenoma detection rate.

Main Results:

• Adenoma detection rate (ADR) was significantly lower in IBD patients (18.6%) compared to non-IBD patients (43.0%) after adjusting for WT.
• The benefit of increased WT on adenoma detection was substantially reduced in IBD patients (2.7% increase per minute) versus non-IBD patients (16.6% increase per minute).
• Achieving a 26% ADR required an estimated WT of 28.2 minutes in IBD patients versus 6.8 minutes in non-IBD patients.

Conclusions:

• IBD-specific procedural demands in patients without endoscopic activity limit effective inspection time during colonoscopy.
• Adenoma detection dynamics are influenced by the unique surveillance context in IBD.
• Current quality metrics for non-IBD screening are likely not directly applicable to IBD surveillance, necessitating the development of IBD-specific quality metrics.