Endoscopy inadequate for detecting small bowel adenocarcinoma in Crohn's disease

Last Updated: 2016-08-01

By Reuters Staff

NEW YORK (Reuters Health) - Endoscopy lacks sensitivity for detecting small bowel adenocarcinoma (SBA) in patients with Crohn's disease, researchers from France and the Netherlands report.

Endoscopic surveillance is recommended to detect colorectal dysplasia or early-stage cancer in patients with long-term colonic inflammatory bowel disease, but there are no data on endoscopic surveillance for dysplasia in Crohn's disease patients at a high risk of SBA.

Dr. Marion Simon from Institut Mutualiste Montsouris in Paris and colleagues investigated the feasibility and benefits of endoscopic screening for dysplasia and SBA in a prospective study of 101 patients with Crohn's disease.

At the time of inclusion, 45 patients had associated colonic Crohn's disease, and 50 patients had undergone previous intestinal surgery. Sixty-eight patients were in clinical remission, and 29 had obstructive symptoms.

Lower exploration was performed in 95 patients, upper exploration was performed in 14 patients, and eight patients underwent both explorations.

There were 276 random biopsies and 112 targeted biopsies. These detected no cases of SBA or high-grade or low-grade dysplasia.

Two patients had indeterminate dysplasia, one of which proved to be undifferentiated SBA, for an overall endoscopic screening dysplasia detection rate of 2%, the researchers report in the Journal of Crohn's and Colitis, online July 14.

During the one-year follow-up, 11 patients without SBA or dysplasia on endoscopic screening developed severe obstructive symptoms, and two additional cases of SBA were diagnosed, both in patients that had long-term stricturing small bowel Crohn's disease with recent obstructive symptoms and a small bowel dilation without visible tumor within the month before inclusion.

Overall, therefore, the prevalence of dysplasia and/or SBA for the entire cohort was 4%. Only one of the three cases of SBA was detected by endoscopic screening, for an endoscopic screening sensitivity of 33%.

"The present study does not support the routine use of endoscopic screening for dysplasia or SBA in patients with small bowel Crohn's disease at risk of SBA," the researchers conclude. "For clinical guidance, surgery should first be considered in Crohn's disease patients with long-term small bowel disease who develop recent obstructive symptoms that suggest associated SBA."

Dr. Simon did not respond to a request for comments.

SOURCE: http://bit.ly/2aIlUac

J Crohns Colitis 2016.