Adherence to Endoscopic Surveillance for Advanced Lesions and Colorectal Cancer in Inflammatory Bowel Disease

An AEG and GETECCU Collaborative Cohort Study

Maria Pilar Ballester; Francisco Mesonero; Pablo Flórez-Diez; Concepción Gómez; Esteban Fuentes-Valenzuela; Noelia Martín; Carla Senosiain; Milagros Vela; Agnes Fernández-Clotet; Pablo Pérez; Cristina Rubín de Célix; Cristina Calviño-Suárez; Benito Hermida; Roser Muñoz; Maria González-Vivo; Eduard Brunet; Nuria Jiménez; Belén Botella; Jorge Yebra; Cristina Suárez-Ferrer; Abdel Bouhmidi; Antonio López-Serrano; Ángel Ponferrada; Carmen Dueñas; Miguel Mínguez


Aliment Pharmacol Ther. 2022;55(11):1402-1413. 

In This Article

Abstract and Introduction


Background and Aims: Patients with colonic inflammatory bowel disease (IBD) have a high risk of colorectal cancer (CRC). Current guidelines recommend endoscopic surveillance, yet epidemiological studies show poor compliance. The aims of our study were to analyse adherence to endoscopic surveillance, its impact on advanced colorectal lesions, and risk factors of non-adherence.

Methods: A retrospective multicentre study of IBD patients with criteria for CRC surveillance, diagnosed between 2005 and 2008 and followed up to 2020, was performed. Following European guidelines, patients were stratified into risk groups and adherence was considered when surveillance was performed according to the recommendations (±1 year). Cox-proportional regression analyses were used to compare the risk of lesions. p-values below 0.05 were considered significant.

Results: A total of 1031 patients (732 ulcerative colitis, 259 Crohn's disease and 40 indeterminate colitis; mean age of 36 ± 15 years) were recruited from 25 Spanish centres. Endoscopic screening was performed in 86% of cases. Adherence to guidelines was 27% (95% confidence interval, CI = 24–29). Advanced lesions and CRC were detected in 38 (4%) and 7 (0.7%) patients respectively. Adherence was associated with increased detection of advanced lesions (HR = 3.59; 95% CI = 1.3–10.1; p = 0.016). Risk of delay or non-performance of endoscopic follow-up was higher as risk groups increased (OR = 3.524; 95% CI = 2.462–5.044; p < 0.001 and OR = 4.291; 95%CI = 2.409–7.644; p < 0.001 for intermediate- and high- vs low-risk groups).

Conclusions: Adherence to endoscopic surveillance allows earlier detection of advanced lesions but is low. Groups at higher risk of CRC are associated with lower adherence.


Inflammatory bowel disease (IBD) is associated with an altered immune response in genetically pre-disposed subjects.[1,2] Due to the inherent chronic mucosal inflammation, patients with colonic IBD have a twofold higher risk of colorectal cancer (CRC) than the general population.[3] IBD CRC typically appears at an early age, in proximal locations, with a higher frequency of multiple and poorly differentiated lesions, representing a greater diagnostic challenge.[4–6]

Several factors increase the risk of CRC, some related to IBD specifically, such as early age at diagnosis, longer disease duration, extent and severity of inflammation, presence of pseudopolyps or stenosis or coexistence of primary sclerosing cholangitis (PSC); and some found in the general population including smoking habit or CRC family history.[7,8]

Endoscopic surveillance has been associated with reduced risk of advanced and interval neoplasia as well as the reduction in mortality from CRC in observational studies.[9–11] Accordingly, several clinical guidelines have been developed for endoscopic surveillance of malignant or premalignant lesions in IBD.[12–21] Nevertheless, only a few epidemiological studies have evaluated compliance with early detection programmes, showing poor adherence even in patients at high risk of CRC.[22–25]

Given the lack of data in our setting, in agreement with previous studies, we hypothesised that adherence to clinical guidelines is low in Spain. The aims of our study were to evaluate: (i) adherence to endoscopic surveillance recommendations, (ii) impact of non-adherence on advanced lesions or CRC detection rate and (iii) risk factors associated with non-adherence.