Abstracts of the 10th Congress of ECCO - European Crohn’s and Colitis Organisation
Results: Incident cases of cancer were observed in 130 IBD pts.: 77
CD (CD-K), 53 UC (UC-K). The frequency of cancer was higher in
CD (59%) than in UC (41%)(p=0.004). Gender, age, IBD duration
were comparable between the 130 IBD-K and 260 IBD-C (p=ns).
Cancer incidence was 3.5/1000 pts., mortality rate 0.4/1000 pts.
Among the 130 IBD-K pts., cancer involved: the gastrointestinal (GI) (41%;n=53) or genitourinary tract (21%;n=27;urinary
n=17),lung (9.2%;n=12),skin (9.2%;n=12: 4 NMSC, 6 melanoma,
2 Kaposi), breast (6.1%;n=8), lymphoma (4.6%,n=6 only in CD:
4 NHL, IS in 4/6, IS+anti-TNFs 1/6), others (8.4%; n=11). The
53 GI tract cancers included: 35 (66%) colorectal (CRC),6 ileal
(11%), 11(23%) others. GI and genitourinary tract cancers were
the first and, respectively, the second more frequent cancer in IBD
(p<0.0001 vs others). Cancer sites were comparable in UC vs CD:
GI (51% vs 34%), genitourinary tract (17% vs 23%), skin (7%
vs 10%), lung (11% vs 8%), breast (6% vs 6%), lymphoma (0
vs 10%;p=ns all), respectively. CRC, including 35/53 (66%) GI
cancers,were more frequent in UC vs CD (63% vs 37%;p<0.0001).
In CD, the percentage of pts. with perforating CD was higher in
those developing any cancer (CD-K vs CD-C:29% vs 16%;p=0.01).
In UC, the percentage of pts. with pancolitis was higher in those
developing any cancer (UC-K vs UC-C: 60% vs 34%;p=0.006).
Risk factors for any cancer included perforating behavior in CD
(OR 2.94; 95% CI 1.25-7.11), pancolitis in UC (2.95;95% CI
1.35-6.71), but not IS and/or anti-TNFs use (CD:OR 1.77;95%
CI 0.95-3.36;UC:OR 0.91; 95% CI 0.31-2.80). Age, active smoking, IBD duration, IS and/or anti-TNFs use did not increase the
overall cancer risk.
Conclusions: In a prospective multicenter study, clinical characteristics, severity and phenotype of IBD (but not IS and/or anti-TNFs use)
appeared to influence the overall cancer risk in IBD. CD phenotype,
pancolitis in UC and penetrating behavior in CD were significant
risk factors for any cancer.
P145
Fecal calprotectin correlates with inflammatory
disease activity as seen on CT imaging of the
small bowel better than clinical assessment
G. Rosenfeld*1, J. Brown2, P. Vos2, J. Leipsic2, R. Enns3, B. Bressler3
University of British Columbia, Medicine, Vancouver, Canada, 2University
of British Columbia, Radiology, Vancouver, Canada, 3University of British
Columbia, Division of Gastroenterology, Vancouver, Canada
1
Background: The Harvey Bradshaw Index (HBI) is a clinical index
used to assess disease activity in patients with Crohn's disease (CD).
The HBI may not correlate well with more objective assessments of
disease activity such as endoscopic, histologic or radiologic evaluations. As a result, biomarkers such as Fecal Calprotectin (FC) have
been developed which may correlate better with objective measures
of disease activity. However, the validity of FC as a marker of active
small bowel inflammation has been questioned. We evaluated the
validity of the HBI and FC to assess for active small bowel inflammation in patients undergoing Computed Tomography Enterography
(CTE) for investigation of potential CD.
Methods: FC and HBI were evaluated in patients enrolled in a
CTE trial undergoing standard and low radiation dose CT scans
for patients with CD. Patients referred to a tertiary IBD centre
for diagnostic CTE for evaluation of potential CD, underwent a
standard exam and a low dose CTE exam in a random sequence on
the same day. The HBI was used to determine clinical disease activity and stool samples for FC were processed in standard fashion
S149
and analyzed using the Buhlmann Quantum BlueTM device. FC
levels were reported with a range from < 100ug/g to >1800 ug/g.
De-identified, randomly ordered images were reviewed by 2 experienced radiologists, independently for signs of small bowel CD
and an overall assessment of "active" or "inactive" was made.
Results: A total of 103 patients underwent CTE scanning and had
HBI and FC Results available for review. 46% of the subjects were
male with mean age of 43.6 (± 15.7) years. Average HBI and FC
scores are presented in (insert Table here)
Conclusions: Fecal Calprotectin accurately identifies the presence or
absence of active inflammation as seen on CTE scanning in patients
being evaluated for small bowel Crohn's disease while the Harvey
Bradshaw index did not correlate with disease activity.
P146
Detection and characterization of colonic
dysplastic lesions in IBD surveillance
colonoscopy - a randomised comparison of
high definition alone with high definition dye
spraying and electronic virtual chromoendoscopy
using iSCAN
M. Iacucci*1, M. Fort Gasia1, S. Urbanski2, P. Minoo2, G. Kaplan1,
R. Panaccione1, S. Ghosh1
1
University of Calgary, Department of Gastroenterology,
Inflammatory Bowel Disease Clinic, Alberta, Canada, 2University of
Calgary, Department of Pathology, Calgary, Canada
Background: The standard of practise for IBD surveillance colonoscopy is now considered dye spraying chromoendoscopy. However,
high definition endoscopy has improved in its resolution significantly.
Therefore, it is important to determine the best technique for detection
of dyspastic lesions (DL) in IBD surveillance colonoscopy. We aimed
to determine the frequency of DL during surveillance colonoscopy in
IBD and to define the endoscopic features of these lesions by using
three different techniques: high definition white light colonoscopy
(HD), dye spraying (0.2% indigo carmine) chromoendoscopy (DSC)
and electronic virtual chromoendoscopy using i-SCAN (EVC).
Methods: A randomized study (NCT02098798) was conducted to
determine the detection rates of DL with HD, DSC or EVC in 95
patients (46 female, median age 52 years, range 22-77 years) with
long standing colitis (8 years from diagnosis, including both UC and
CD). Patients with inactive disease were enrolled in 1:1:1 ratio into
three arms of the study. Colonoscopy was performed using a Pentax
EPKi processor and high-resolution video colonoscope (EC-3490Fi;
Pentax Tokyo). Endoscopic colonic lesions were classified by size,
Kudo pit pattern and Paris classification. Lesions of dysplasia-associated lesion or masses and adenoma-like masses (DALMs/ALMs),
sessile serrated adenomas (SSAs), adenoma-like polyps (ALPs),
hyperplastic polyps (HPs), and inflammatory polyps (IPs) were
identified.
Results: Patients were randomized into three groups, HD (n=32, 33.7%),
VEC (n=33, 34.7%) and DSC (n=30, 31.6%). 47 DL were found in total.
Thirty (63.8%) were detected in the HD group (8 SSAs, 20 ALPs and 2
DALMs), 6 (12.8%) in the DCE group (6 ALPs) and 11 (23.4%) in the
EVD group (7 SSAs, 1 ALP and 3 DALMs). The endoscopic characteristics
of SSA were <5mm in size (66.6%), non-polypoid (53.3%) and Kudo pit
pattern IIO (93.3%). Similarly, ALPs were <5mm in size (77.7%), polypoid (55.5%) and Kudo pit pattern III (77.7%). Finally, DALMs were
<5mm (60%), non-polypoid (60%) and Kudo pit pattern IIIL (40%)
and IV (40%). Among the three groups, HD had a sensitivity of 86.67%,