Introduction
The BSG IBD surveillance guideline update includes an advanced colorectal neoplasia (aCRN) risk assessment tool1,2 (aCRN RAT), a dynamic evidence-based prediction model to determine personalised 5-year aCRN risk to inform surveillance interval. At Oxford University Hospitals NHS Trust, aCRN RAT has been incorporated into IBD surveillance assessment.
Aims & Methods
A retrospective cohort study was conducted, evaluating electronic records of patients who underwent surveillance colonoscopy at OUH NHS Trust from July-August 2025. MDT determined surveillance intervals were compared with strict application of aCRN RAT in all eligible cases, and the alternative approach of ascribing single risk factors to surveillance intervals, also endorsed by current BSG2 and ECCO3 malignancy guidance (BSG 2025 boxes and ECCO 2023 boxes).
Results
61 (F:M = 30:31) patients underwent IBD surveillance colonoscopy. Median (IQR) age was 47.1(36.2-62.2) years. All patients had colonic IBD (CD:UC:IBD-PSC = 8:43:10). 47 patients fulfilled eligibility criteria for use of aCRN RAT, with median 5-year aCRN risk of 1.1% (0.5-1.5%). 1 case of multifocal LGD was detected, with patient counselled for colectomy. Surveillance intervals as determined by OUH surveillance MDT with IBD clinician patient specific input, exclusive use of aCRN RAT when patient eligible, BSG 2025 boxes or ECCO 2023 boxes are summarised in figure 1.
OUH surveillance MDT stepped down surveillance in 37/61(60.7%) cases reviewed, exclusive use of aCRN RAT when patient eligible recommended step down in 45/61(73.8%) cases, whereas BSG 2025 and ECCO 2023 boxes recommended step down in 14/61(23.0%) and 0/61(0%) respectively (Chi sq 86.93 3df p<0.0001). Deviations between OUH MDT outcome and aCRN RAT informed surveillance intervals involved cases of PSC or young age, with concerns regarding cumulative risk.
Conclusion
The incorporation of aCRN RAT into determination of surveillance intervals significantly reduces need for future colonoscopy. When this model is used, care must be taken to re-evaluate patients following subsequent disease flares, given the dynamic nature of risk.
References
- https://ibd-dysplasia-calculator.bmrc.ox.ac.uk/
- East JE et al. BSG IBD Surveillance guidelines 2025
- Gordon H et al. ECCO IBD malignancy guideline 2023
Disclosure
Hannah Gordon received consultancy and/or speaker fees from: J&J, Ferring, AbbVie, IBDscope, Takeda, Lilly, Galapagos
Alissa Walsh received grants/research support from: AbbVie, Alfasigma, Bristol-Myers Squibb, Buhlmann, Helmsley Trust, Galapagos, Janssen, Lilly, Pfizer, Takeda, and Norman Collisson Foundation and consultancy and/or speaker fees from: AbbVie, AstraZeneca, Bristol-Myers Squibb, Buhlmann, Falk, Ferring, Galapagos, Janssen, Lilly, Pfizer, Takeda
Oliver Brain received consultancy and/or speaker fees from: AbbVie, Bristol Myers Squibb, Galapagos NV, Janssen-Cilag, and Takeda
Vincent Cheung received consultancy and/or speaker fees from: Alfasigma, Galapagos, Abbvie, Alfasigma, Galapagos, GenesisCare and Celltrion
Lydia White received consultancy and/or speaker fees from: Pfizer, BMS, Lilly, Dr Falk, Takeda