Original Paper Received: November 18, 2013 Accepted: April 21, 2014 Published online: September 2, 2014

Digestion 2014;90:58–62 DOI: 10.1159/000363053

Use of Surveillance Colonoscopy in Medicare Patients with Inflammatory Bowel Disease prior to Colorectal Cancer Diagnosis Yize R. Wang a John R. Cangemi b Edward V. Loftus, Jr. c Michael F. Picco b  

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Division of Gastroenterology and Liver Diseases, Cooper Medical School of Rowan University, Camden, N.J., Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Fla., and c Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn., USA  

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Key Words Colorectal cancer · Inflammatory bowel disease · Crohn’s disease · Ulcerative colitis · Surveillance colonoscopy

Abstract Background: Patients with longstanding inflammatory bowel disease (IBD) involving large intestine proximal to rectum are considered to be at increased risk for colorectal cancer (CRC). One prior study showed low utilization of surveillance colonoscopy in patients with ≥8 years of ulcerative colitis (UC) in the USA. Aims: To study use of surveillance colonoscopy among Medicare beneficiaries with IBD in the 2-year period prior to CRC diagnosis. Data and Methods: Our study sample included Medicare beneficiaries in the SEER-Medicare-linked database who were diagnosed with CRC during 2001–2005 and had ≥3 physician visits with ICD9 diagnosis code for IBD prior to CRC diagnosis. Medicare beneficiaries aged >85 years without Part B coverage or enrolled in HMOs were excluded. Colonoscopy performed within 6–30 months prior to CRC diagnosis was defined as surveillance colonoscopy. The χ2 test and multivariate logistic regression were used in statistical analysis. Results: Of 241 Medicare beneficiaries with IBD and diagnosed with CRC, 92 (38%) patients underwent ≥1 surveillance colonoscopy in the 2 years prior to cancer diagnosis. The use of surveillance colonoscopy was similar between Crohn’s disease

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(28/86, 33%) and UC (64/155, 41%). In multivariate logistic regression, older age (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94–0.99) was negative associated with surveillance colonoscopy use and personal history of colon polyp (OR 2.73, 95% CI 1.09–6.87) was positively associated with surveillance colonoscopy use. Conclusions: Use of surveillance colonoscopy was low among Medicare beneficiaries with IBD in the 2 years prior to CRC diagnosis. © 2014 S. Karger AG, Basel

Introduction

Patients with longstanding inflammatory bowel disease (IBD) involving the large intestine proximal to the rectum are considered to be at increased risk for colorectal cancer (CRC) [1–15]. Current guidelines recommend intensive surveillance colonoscopy for IBD patients with longstanding left-sided or extensive colitis [3–5, 7, 10, 13, 14, 16, 17]. Adherence to surveillance colonoscopy guidelines for patients with ulcerative colitis (UC) has varied in clinical practice. Surveys of gastroenterologists showed that most gastroenterologists performed some form of surveillance for UC patients [18–20]. However, one survey suggested that only about half of IBD specialists and community gastroenterologists would recommend surveillance colonoscopy for a hypothetical patient with Yize R. Wang, MD, PhD Cooper Digestive Health Institute 501 Fellowship Road, Suite 101 Mount Laurel, NJ 08054 (USA) E-Mail wang-yize @ cooperhealth.edu

left-sided colitis [21]. Moreover, only 25% of patients with ≥8 years of UC underwent surveillance colonoscopy in an integrated healthcare delivery system in the USA [22]. In this retrospective, observational study of Medicare patients with IBD and diagnosed with CRC in the USA during 2001–2005, we studied the use of surveillance colonoscopy in the 2 years prior to CRC diagnosis. We also used multivariate logistic regression analysis to identify factors associated with use of surveillance colonoscopy among these high-risk IBD patients.

Table 1. Characteristics of CRC patients with IBD

Patients, n Age, mean ± SD Female, n (%) Non-white race, n (%) Crohn’s disease, n (%) PSC, n (%) Family history of CRC, n (%) Personal history of colon polyp, n (%)

241 74.1±9.7 127 (52.7) 21 (8.7) 86 (35.7)

Use of surveillance colonoscopy in medicare patients with inflammatory bowel disease prior to colorectal cancer diagnosis.

Patients with longstanding inflammatory bowel disease (IBD) involving large intestine proximal to rectum are considered to be at increased risk for co...
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