Annual vs biennial colonoscopy in UC with PSC
Does annual colonoscopic surveillance reduce CRC incidence more than biennial surveillance in patients with UC and PSC
What is known
- Compared with no surveillance, CRC deaths were reduced 69% by biennial and 81% by annual colonoscopy in the IBD-PSC model. 1
- Annual surveillance prevented an additional 19% of cancer cases and 29% of cancer deaths versus biennial, at $174,650 per QALY. 1
- In 98% of model iterations annual surveillance exceeded the $50,000/QALY threshold; it remained cost-effective more often only under low adherence assumptions. 1
- One review states that for patients with PSC and UC, surveillance colonoscopy should be performed annually beginning at diagnosis. 2
What is unknown / caveats
- One guideline recommends annual colonoscopy from diagnosis in UC-PSC 2, while an economic model finds annual surveillance rarely cost-effective versus biennial 1
- The core finding derives from a single 2014 cost-effectiveness model, not a head-to-head clinical trial measuring actual cancer incidence
- Reductions are modeled outcomes; results shift substantially with neoplasia incidence and adherence assumptions
- The magnitude of benefit depends heavily on the assumed neoplasia incidence and surveillance adherence in the model.
References
- Negrón ME, Kaplan GG, Barkema HW, Eksteen B, Clement F, Manns BJ, Coward S, Panaccione R, Ghosh S, Heitman SJ. Colorectal cancer surveillance in patients with inflammatory bowel disease and primary sclerosing cholangitis: an economic evaluation. Inflamm Bowel Dis. 2014. PMID: 25230162.
- Rabbenou W, Ullman TA. Risk of Colon Cancer and Recommended Surveillance Strategies in Patients with Ulcerative Colitis. Gastroenterol Clin North Am. 2020. PMID: 33121696.
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⚠ Required context not in this corpus (severe). UC with PSC carries a substantially increased risk of colorectal dysplasia/carcinoma versus UC alone, OR 4.79 (95% CI 3.58-6.41) (Soetikno 2002 meta-analysis, PMID 12085034).
Why this matters: A clinician told only that a single cohort found no excess CRC could conclude risk is not elevated in UC-PSC and de-intensify dysplasia surveillance in the highest-risk colitis population, risking interval cancer.
Added by the landmark interlock. This corpus is surgical in scope and cannot admit the source paper (PMID 12085034). Not generated by the RAG.
Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.
Reviewer notes