A238 BEST APPROACH TO SURVEILLANCE COLONOSCOPY FOR COLORECTAL CANCER IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS AND INFLAMMATORY BOWEL DISEASE
Bibliographic record
Abstract
Abstract Background Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver disease and it has been recognized as a risk factor for hepatobiliary and colorectal carcinoma (CRC). Inflammatory bowel disease (IBD) is associated with a 6-fold increased risk of CRC as compared to the general population but with co-existing PSC, this risk rises to 30-fold and hence CRC surveillance is critical in these patients. Aims We performed a systematic review of the literature on surveillance colonoscopy for CRC in patients with PSC-IBD, with the aim of identifying the most effective approach. Methods The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under ID 472215. The search was executed in the databases Medline, EMBASE, Cochrane, Web of science, Scopus and Google Scholar databases from 1947 to May 2023. Observational or randomized controlled studies were included if patients had PSC-IBD (paediatric or adult) undergoing surveillance colonoscopy. There was no restriction for language. We used a modified version of the Newcastle–Ottawa Quality Assessment Scale to assess the risk of bias. Neoplasia was defined as the presence of low-grade dysplasia, high grade dysplasia or colorectal carcinoma. Results Amongst 2900 studies identified, 7 studies met the inclusion criteria with a total number of 379 PSC-IBD patients and 1884 IBD patients (all adult). The median frequency of surveillance colonoscopy was every 0-2 years. The most common endoscopic presentation of dysplasia in PSC-IBD was a normal appearing mucosa or subtle abnormalities such as mild inflammation. Three studies performed random and targeted biopsies and only one study did quadruple random biopsy (every 10 cm of the colon). Two studies used chromoendoscopy and high-definition endoscopy whereas another two studies used white light colonoscopy. Studies varied in terms of the number of biopsies taken and timing for the frequency and initiation of surveillance. Outcomes included intensive surveillance, resection, and colectomy. Our meta-analysis of 2 studies that reported the prevalence of colorectal dysplasia in PSC-IBD patients revealed a pooled prevalence of 21% (95% CI 1.4%-28%, I2 = 0%, Pampersand:003C0.597, shown in Figure 1) Conclusions Colorectal dysplasia is prevalent in patients with PSC-IBD and is associated with worse disease outcomes. As a result, PSC-IBD patients should be screened annually from the diagnosis of PSC. However, there is variation in practice, and no clear consensus on the best approach to perform screening colonoscopy in this population. Literature comparing various approaches is very sparse. Additional high-quality studies on this subject are needed to guide practice, particularly in paediatrics where data are non-existent. Figure 1: Forest plot for meta-analysis of CRC dysplasia prevalence in PSC-IBD Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.044 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.007 |
| Bibliometrics | 0.006 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".