S. Mehta

Mo1302 Incidental Diagnosis of Inflammatory Bowel Disease in a British Bowel Cancer Screening Cohort: A Multi-Centre Study

Introduction The UK Bowel Cancer Screening Programme (BCSP) was launched in 2006 and rolled out in successive waves covering the entire population of England and Wales. It screens individuals aged 60–69 years with a Faecal Occult Blood test (FOBt) followed by a screening colonoscopy if FOBt positive. Our study aimed to quantify the incidental diagnosis of Inflammatory Bowel Disease (IBD) through BCSP and patient outcome in this cohort. Methods We conducted a retrospective review of BCSP outcomes at our centres from launch in February 2007 until September 2011. Screening data included the number of patients invited, number screened (FOBt outcome “normal” or “abnormal”) and number of colonoscopies performed. In those with newly diagnosed IBD at colonoscopy confirmed on histology, clinical data including demographics, disease characteristics, treatment and outcome were obtained from case note and electronic patient record review. Results Of 378 424 patients invited, 172 244 were screened, representing an uptake of 45.52% and FOBt positivity of 2.71%. Colonoscopy was performed in 4195 patients (female 1761). Polyps were detected in 1870 (40.14%), cancer in 279 (5.99%) and 1216 (26.10%) had a normal examination. 83 patients had endoscopic appearance suggestive of IBD, confirmed at histology in 44. Seven patients were excluded as the diagnosis of colitis preceded the screening examination on case note review. Eleven of 37 incidental cases were female. Median age at diagnosis was 64. Twelve patients had Crohn9s disease (CD), 22 ulcerative colitis (UC) and three had IBD-type unclassified (IBDU). 31 patients had follow-up data available with a mean follow-up period of 24.4 months. Fifteen patients (48.4%) were asymptomatic at diagnosis. Mean values for CRP were 11.8, Hb 13.8, Platelets 278.5, and Albumin 42.9. Treatment included steroids (8), 5-ASA (25), immunomodulators (azathioprine 5; methotrexate 1) and anti-TNF (infliximab 2; adalimumab 1). None required surgery. Those requiring immunomodulators and/or anti-TNF therapy (male 4; female 1) had asymptomatic extensive UC, symptomatic left sided UC, symptomatic left-sided IBDU, symptomatic Crohn9s colitis and symptomatic stricturing terminal ileal CD at diagnosis. Conclusion An incidental diagnosis of IBD is not uncommon and with the advent of bowel cancer screening this number is set to increase. These patients may present an important model for study of early disease with novel insights and evolving treatment paradigms. Competing interests None declared.

Current Practices in Ileal Pouch Surveillance for Ulcerative Colitis Patients in Three London IBD Referral Centres

Introduction There are no universally accepted guidelines regarding surveillance of IBD patients after ileal pouch-anal anastomosis (IPAA). The BSG suggest ‘considering’ pouchoscopy and biopsy but accepts ‘there is no clear evidence that surveillance is beneficial and thus it cannot be strongly recommended’. We assessed how frequently pouch surveillance is carried out at our centres. We also evaluated the approaches used for pouchoscopy and the use of endoscopic biopsies. Method The records of 177 patients who underwent IPAA for IBD at three London IBD referral centres (Guy’s and St Thomas’, University College London and St Mark’s Hospitals) were reviewed. Patients with Crohn’s or less than 1 year post-surgical follow-up, were excluded. Data regarding the endoscopic follow-up of the remaining 126 patients was collected retrospectively. Fisher’s exact (categorical) and signed rank sum (continuous) tests were used. Results 15/126 (12%) had never undergone pouchoscopy for any indication. Of the 111 who had, the median interval between pouch surgery and first pouchoscopy was 1.3 years (0.2–6.4). Median number of pouchoscopies was 3 (0–11), carried out at a median frequency of every 2.4 years (0.9–8.1). Two rectal cuff cancers were found. 59/126 (47%) had never undergone pouchoscopy with surveillance as the sole indication and no significant differences were found between sub-groups. Median pouch duration 7.1y surveillance, 8.4y none (p=0.193). Gastro, Surgery and joint-care surveillance rates: 7/16 (44%), 28/46 (61%) and 32/64 (50%), respectively (p=0.382). Pouchitis history surveillance rates: present 29/51 (57%), absent 36/73 (49%)(p=0.501). Rates of examination and biopsy by pouch region shown in fig 1. Conclusion We demonstrated wide variation in endoscopic surveillance of UC-IPAA patients, even amongst experienced clinicians. Some patients underwent several pouchoscopies for surveillance, whereas others had none. In additional, the decision whether to perform surveillance pouchoscopy did not seem to be related to risk factors such as pouch duration. Moreover, endoscopic pouch assessments could be considered incomplete in a proportion of patients with no description of the prepouch ileum or rectal cuff/anal transition zone. Disclosure of Interest None Declared