S1966 Adherence to Colon Cancer and Dysplasia Surveillance Guidelines Among Patients With Ulcerative Colitis and Crohn's Colitis

Introduction: Patients with Ulcerative colitis (UC) and Crohn’s colitis (CC) are at an increased risk of developing colorectal cancer (CRC). In a 2021 clinical practice update, the American Gastroenterological Association (AGA) recommends surveillance colonoscopy at varying intervals (1, 2-3, or 5 years) to assess for colonic dysplasia or CRC. The recommended interval depends on risk factors such as medical/family history, extent of inflammation, and history of dysplasia. This study evaluated adherence to these guidelines at Westchester Medical Center (WMC). Methods: A retrospective chart review was conducted for patients aged ≥18 years with UC or CC who received a colonoscopy for dysplasia/CRC surveillance between October 2021 and July 2024. Patients were eligible if they were diagnosed ≥8 years prior to colonoscopy, or at the time of diagnosis if they also had primary sclerosing cholangitis (PSC). All procedures were performed with high-resolution colonoscopes, with both targeted and random biopsies. Endoscopic, histologic, laboratory, and historical data were collected. The recommended surveillance interval was assessed based on AGA guidelines and was compared to the interval documented on the endoscopy report. Descriptive statistics were used for analysis. Results: Of 311 charts reviewed, 113 met inclusion criteria. Sixty-three were men (56%). Ages ranged from 20 to 83 (median 51). Fifty-four were diagnosed with UC (48%) and 57 with CC (50%). Twelve had PSC (11%), 7 had history of colonic dysplasia (6%), and 6 had first degree relative with CRC history (5%). On colonoscopy, 15 had evidence of moderate/severe mucosal inflammation (13%), 5 had dense pseudopolyps (4%), and 24 had mucosal scarring (21%). On histology, 35 had active inflammation (31%) and 1 had dysplasia (1%). Seventy patients (62%) had a documented surveillance interval for next colonoscopy; of these, 43 were concordant with the AGA guideline (61%). Among discordant cases, 26 were recommended a repeat colonoscopy earlier than the AGA guideline recommends (96%). Conclusion: Our findings demonstrate suboptimal documentation and adherence to AGA-recommended surveillance intervals for patients with UC and CC undergoing CRC surveillance at WMC. When documented on endoscopy reports, surveillance intervals were often shorter than AGA guideline recommendations, potentially leading to unnecessary procedures and increased resource utilization. We propose targeted interventions such as EMR-based prompts and educational outreach to improve adherence to AGA guidelines.