PMO-251 A retrospective audit of colorectal cancer surveillance in inflammatory bowel disease in secondary care

Abstract

Background: Patients with colitis are at increased risk of colorectal cancer (CRC). Colonoscopic surveillance to detect dysplasia and early cancers has been advocated by the British Society of Gastroenterology since 2002 [1]. The aim was to assess whether patients with colitis had received appropriate surveillance. Methods: A 3 stage audit was performed in 3 GP practices and a secondary care trust. Patients with IBD were identified from primary care records and secondary care databases. Patients with colitis who developed CRC were identified from cancer Multidisciplinary Team summaries. Paper records were retrospectively reviewed. Results: 166 patients (0.6%) were identified with IBD. 100 patients (60%) had colitis extent requiring surveillance; 59 (59%) had symptom onset >10 years; 10 (17%) underwent colonoscopy at 8 10 years; 19 (32%) had not; 6 (10%) were due in 2010. 11 (19%) had unknown disease extent but no clear surveillance; 13 (22%) had no record of colonoscopy. Of 59 patients, 37 (63%) were eligible for repeat colonoscopy; 3 (8%) underwent this, 27 (73%) had not and 7 (19%) records were unclear. 45 colitis patient records in secondary care were reviewed. 35 (78%) had colitis extent requiring surveillance. 26 patients (58%) had symptom onset >10 years; 11 patients (42%) underwent screening colonoscopy at 8 10 years; 15 (58%) did not. 1 patient underwent colonoscopy but date of diagnosis was unclear. 9 patients (35%) underwent inconsistent surveillance, in 6 patients (23%) there was no record of a colonoscopy. 24 patients were eligible for repeat colonoscopy; 3 (13%) underwent this at the advised interval; 1 patient was due in 2011; 11 (46%) underwent inconsistent surveillance. 9 (38%) patients did not undergo any surveillance. 16 cases of colitis and CRC were identified from our IBD patient cohort. 12 patients (75%) had symptom onset of >10 years; 3 patients (25%) underwent screening colonoscopy at 8 10 years. 8 patients (75%) underwent surveillance, of these 2 (25%) had surveillance in accordance with 2002 BSG guidelines, and in 6 (75%) it was inconsistent. 4 patients (33%) did not undergo any surveillance. Conclusions: Patients with colitis in primary and secondary care have not received appropriate CRC surveillance according to the BSG guidelines. These results emphasise the need for a robust coordinated surveillance programme and a reliable interface between primary and secondary care.