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Consecutive negative findings on colonoscopy during surveillance predict a low risk of advanced neoplasia in patients with inflammatory bowel disease with long-standing colitis: results of a 15-year multicentre, multinational cohort study
  1. Joren R ten Hove1,
  2. Shailja C Shah2,3,
  3. Seth R Shaffer4,
  4. Charles N Bernstein4,
  5. Daniel Castaneda2,
  6. Carolina Palmela2,
  7. Erik Mooiweer1,
  8. Jordan Elman2,
  9. Akash Kumar2,
  10. Jason Glass2,
  11. Jordan Axelrad5,
  12. Thomas A Ullman2,
  13. Jean-Frederic Colombel2,
  14. Joana Torres2,6,
  15. Adriaan A van Bodegraven7,8,
  16. Frank Hoentjen8,9,
  17. Jeroen M Jansen8,10,
  18. Michiel E de Jong8,9,
  19. Nofel Mahmmod8,11,
  20. Andrea E van der Meulen-de Jong8,12,
  21. Cyriel Y Ponsioen8,13,
  22. Christine J van der Woude8,14,
  23. Steven H Itzkowitz2,
  24. Bas Oldenburg1,8
  1. 1 Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
  3. 3 Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  4. 4 IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada
  5. 5 Division of Gastroenterology, Columbia University, New York, USA
  6. 6 Surgical Department, Gastroenterology Division, Hospital Beatriz Angelo, Loures, Lisboa, Portugal
  7. 7 Department of Gastroenterology and Hepatology, Vrije Universiteit Medical Center Amsterdam, Amsterdam, The Netherlands
  8. 8 Dutch Initiative on Crohn and Colitis (ICC), The Netherlands
  9. 9 Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
  10. 10 Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis Amsterdam, Amsterdam, The Netherlands
  11. 11 Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
  12. 12 Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
  13. 13 Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, Netherlands
  14. 14 Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
  1. Correspondence to Dr Bas Oldenburg, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; b.oldenburg{at}


Objectives Surveillance colonoscopy is thought to prevent colorectal cancer (CRC) in patients with long-standing colonic IBD, but data regarding the frequency of surveillance and the findings thereof are lacking. Our aim was to determine whether consecutive negative surveillance colonoscopies adequately predict low neoplastic risk.

Design A multicentre, multinational database of patients with long-standing IBD colitis without high-risk features and undergoing regular CRC surveillance was constructed. A ‘negative’ surveillance colonoscopy was predefined as a technically adequate procedure having no postinflammatory polyps, no strictures, no endoscopic disease activity and no evidence of neoplasia; a ‘positive’ colonoscopy was a technically adequate procedure that included at least one of these criteria. The primary endpoint was advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia or CRC.

Results Of 775 patients with long-standing IBD colitis, 44% (n=340) had >1 negative colonoscopy. Patients with consecutive negative surveillance colonoscopies were compared with those who had at least one positive colonoscopy. Both groups had similar demographics, disease-related characteristics, number of surveillance colonoscopies and time intervals between colonoscopies. No aCRN occurred in those with consecutive negative surveillance, compared with an incidence rate of 0.29 to 0.76/100 patient-years (P=0.02) in those having >1 positive colonoscopy on follow-up of 6.1 (P25–P75: 4.6–8.2) years after the index procedure.

Conclusion Within this large surveillance cohort of patients with colonic IBD and no additional high-risk features, having two consecutive negative colonoscopies predicted a very low risk of aCRN occurrence on follow-up. Our findings suggest that longer surveillance intervals in this selected population may be safe.

  • colorectal cancer
  • dysplasia
  • Crohn’s disease
  • ulcerative colitis

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  • JRH and SCS contributed equally.

  • Contributors JRtH, SCS: study concept and design, data acquisition, data analysis and interpretation, manuscript writing. SRS, CNB, DC, CP, EM, JE, AK, JG, AAvB, FH, JMJ, MEdJ, NM, AEvdM-dJ, CYP, CJvdW, JT: data acquisition, review of final manuscript. J-FC, TAU, SHI, BO: study concept and design, data interpretation, critical revision of the manuscript for important intellectual content.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional Review Board at all sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.