ASSURANCE: A multi-centre practical and systematised approach to colorectal cancer surveillance in patients with inflammatory bowel disease
Refereed conference paper presented and published in conference proceedings


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AbstractIntroduction: Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). However, adherence to existing surveillance guidelines amongst clinicians remains poor owing, in part, to the complexity of the disease and the surveillance process. ASSURANCE, a user-friendly, online, cloud-based software, was developed to simplify CRC risk stratification, facilitate long-term individualized CRC surveillance, provide an immediate surveillance colonoscopy report, and collect surveillance data on large populations. ASSURANCE also provides reminders to aid clinicians in scheduling colonoscopies, in addition to providing access to up-to-date guidelines for surveillance. Since initiation in 2014, ASSURANCE has garnered active participation in 21 hospital centres across Australia, Singapore and Hong Kong. Methods: We reviewed the data on all centres and patients enrolled. Data were extracted from the ASSURANCE database and analysed using Excel and SPSS. Results: One hundred twelve IBD patients completed initial CRC surveillance assessments comprising 72 (64%) with ulcerative colitis (UC), 35 (31%) with Crohn's disease (CD) and 5 (4%) with indeterminate colitis (IC) with mean disease duration of 15, 12 and 9 years, respectively. Amongst UC patients, maximum documented disease extent was pan-colitis in 46 (64%), left-sided in 13 (18%) and distal in 6 (8%), whilst for CD, 15 (43%), 13 (37%) and 2 (6%) patients had colonic, ileocolonic and ileal disease, respectively. Majority of UC patients (97 patients, 78%) were stratified to low and moderate CRC risks (recommended surveillance colonoscopy in three and one year(s) respectively) with 11 (10%) stratified to high and highest risk levels with recommended surveillance in six and three months, respectively. Major risk factors included structural changes in 29 patients, previous dysplasia on flat mucosa in 6, family history of CRC in 4, primary sclerosing cholangitis in 4, and history of adenomatous polyps in 2. Twenty-two patients have had additional follow-up colonoscopies three months to two years after initial surveillance, 19 of whom were classified to have at least moderate CRC risk; 21 repeat colonoscopies were for CRC surveillance, and 1 was an interval colonoscopy; 5 of these were a deviation from the guideline recommendation, 3 due to doctor preference and 2 to patient preference. Two patients with low-grade dysplasia were detected on surveillance colonoscopies, one using white-light high-definition and one chromoendoscopy, confocal and narrow-band imaging. A total of 134 colonoscopies have been performed: 59 (44%) using whitelight high-definition, 45 (34%) chromoendoscopy and 18 (13%) narrowband imaging. In 90 (67%) colonoscopies patients had <10 random biopsies and in 44 (33%) >10 biopsies. Deviations from recommendations on surveillance colonoscopy occurred in 25 patients; 12 due to patient preference, 11 to doctor preference and other reasons in 2. Conclusions: ASSURANCE is a streamlined practical surveillance tool that has become integrated into clinical care, with systematised follow-up and standardised colonoscopic practice. It also documents surveillance practice. It will allow physician, national and international CRC surveillance practice data and outcomes to be determined.
All Author(s) ListSoh AY, Ong DE, Hartono JL, Hamilton AL, Yip CK, Gowans M, Kyaw MH, Ng SC, Lust M, Leong R, Kamm MA
Name of ConferenceAsia Pacific Digestive Week
Start Date of Conference02/11/2016
End Date of Conference05/11/2016
Place of ConferenceKobe
Country/Region of ConferenceJapan
Proceedings TitleJournal of Gastroenterology and Hepatology
Detailed descriptionIntroduction: Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). However, adherence to existing surveillance guidelines amongst clinicians remains poor owing, in part, to the complexity of the disease and the surveillance process. ASSURANCE, a user-friendly, online, cloud-based software, was developed to simplify CRC risk stratification, facilitate long-term individualized CRC surveillance, provide an immediate surveillance colonoscopy report, and collect surveillance data on large populations. ASSURANCE also provides reminders to aid clinicians in scheduling colonoscopies, in addition to providing access to up-to-date guidelines for surveillance. Since initiation in 2014, ASSURANCE has garnered active participation in 21 hospital centres across Australia, Singapore and Hong Kong. Methods: We reviewed the data on all centres and patients enrolled. Data were extracted from the ASSURANCE database and analysed using Excel and SPSS. Results: One hundred twelve IBD patients completed initial CRC surveillance assessments comprising 72 (64%) with ulcerative colitis (UC), 35 (31%) with Crohn's disease (CD) and 5 (4%) with indeterminate colitis (IC) with mean disease duration of 15, 12 and 9 years, respectively. Amongst UC patients, maximum documented disease extent was pan-colitis in 46 (64%), left-sided in 13 (18%) and distal in 6 (8%), whilst for CD, 15 (43%), 13 (37%) and 2 (6%) patients had colonic, ileocolonic and ileal disease, respectively. Majority of UC patients (97 patients, 78%) were stratified to low and moderate CRC risks (recommended surveillance colonoscopy in three and one year(s) respectively) with 11 (10%) stratified to high and highest risk levels with recommended surveillance in six and three months, respectively. Major risk factors included structural changes in 29 patients, previous dysplasia on flat mucosa in 6, family history of CRC in 4, primary sclerosing cholangitis in 4, and history of adenomatous polyps in 2. Twenty-two patients have had additional follow-up colonoscopies three months to two years after initial surveillance, 19 of whom were classified to have at least moderate CRC risk; 21 repeat colonoscopies were for CRC surveillance, and 1 was an interval colonoscopy; 5 of these were a deviation from the guideline recommendation, 3 due to doctor preference and 2 to patient preference. Two patients with low-grade dysplasia were detected on surveillance colonoscopies, one using white-light high-definition and one chromoendoscopy, confocal and narrow-band imaging. A total of 134 colonoscopies have been performed: 59 (44%) using whitelight high-definition, 45 (34%) chromoendoscopy and 18 (13%) narrowband imaging. In 90 (67%) colonoscopies patients had <10 random biopsies and in 44 (33%) >10 biopsies. Deviations from recommendations on surveillance colonoscopy occurred in 25 patients; 12 due to patient preference, 11 to doctor preference and other reasons in 2. Conclusions: ASSURANCE is a streamlined practical surveillance tool that has become integrated into clinical care, with systematised follow-up and standardised colonoscopic practice. It also documents surveillance practice. It will allow physician, national and international CRC surveillance practice data and outcomes to be determined.
Year2016
Month10
Volume Number31
Pages146 - 147
ISSN0815-9319
LanguagesEnglish-United States

Last updated on 2018-18-01 at 11:20