Patients’ perception of colonoscopy and acceptance of colonoscopy based IBD related colorectal cancer surveillance

ABSTRACT

Objectives

Patients with Inflammatory Bowel Disease (IBD) are at an increased risk of colorectal cancer (CRC). Current surveillance for CRC involves often uncomfortable colonoscopy.

To assess IBD patients’ perception of colonoscopy and examine preferences for hypothetical alternatives.

Methods

IBD patients in clinical remission rated acceptable frequency of colonoscopy and hypothetical alternatives to colonoscopy-based surveillance (preference of yearly blood, yearly stool or 5-yearly imaging tests over 5-yearly colonoscopy). Participants rated discomfort of the last colonoscopy was compared with hospital records.

Results

Of 282 patients with recollection of colonoscopy 65.8% rated the discomfort as moderate to severe, which correlated weakly with endoscopists’ perception (r = 0.225; p = 0.015). There were no significant differences in patients’ or endoscopists’ perceptions of discomfort between sedated and unsedated colonoscopies. Undergoing a yearly colonoscopy was acceptable to 49.5%. Experienced discomfort did not correlate with patients’ views on acceptable frequency of surveillance colonoscopy. Over 95% of patients would prefer blood, stool, or imaging tests over colonoscopy but nearly half expected sensitivities ≥95%.

Conclusion

A large proportion of IBD patients experienced colonoscopy as moderate to severely uncomfortable but would still accept colonoscopy surveillance frequency according to current guidance. Participants expected sensitivities ≥95% for potential alternatives to colonoscopy-based surveillance programs.

Expert Opinion

IBD patients frequently experience colonoscopy as uncomfortable but accept colonoscopy as the gold standard for colorectal cancer surveillance. The currently suggested frequencies of surveillance by colonoscopy are acceptable to IBD patients. They do however express a clear preference for non-invasive surveillance techniques. Some promising initial results have been obtained based on faecal or blood sampling. However, these have yet to be tested in large prospective studies to determine their sensitivity and specificity. IBD patients expect these non-invasive tests to meet high standards for sensitivity. In our view it is feasible that analogue to faecal immunochemistry based testing for general population bowel cancer screening non-invasive IBD surveillance techniques will emerge. This could lead to a reduction in the need for colonoscopy to those testing positive on faecal or blood based surveillance.

KEYWORDS:

• Inflammatory bowel disease
• ulcerative colitis
• Crohn’s disease
• colorectal cancer
• surveillance
• colonoscopy

Declaration of interest

C P Selinger has received unrestricted research grants from Janssen and AbbVie, has provided consultancy to Warner Chilcott, Dr Falk, AbbVie, Takeda, Fresenius Kabi and Janssen, and had speaker arrangements with Janssen, Dr Falk, AbbVie, Pfizer, and Takeda. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

C P Selinger designed the study, analyzed the data and wrote the draft manuscript. All authors contributed equally to data collection and interpretation of results. All other authors critically reviewed the manuscript.

Additional information

Funding

AbbVie provided funding for the study via an unrestricted research grant. AbbVie was not involved in the conduct and analysis of the study, nor the development or review of the manuscript with the authors. This manuscript reflects the opinions of the authors. The authors determined the final content, and all authors read and approved the final manuscript.