Endoscopic surveillance of patients with inflammatory bowel dis­ease and primary sclerosing cholangitis – a single center experience

Abstract

Introduction: Patients with primary sclerosing cholangitis (PSC) associated with inflammatory bowel dis­ease (PSCIBD) are at increased risk of colorectal neoplasia. The aim of this study was to assess the incidence of colorectal neoplasia and identify risk factors for their development during long-term endoscopic surveillance in a tertiary center. Methods: This retrospective study included 365 patients with PSC-IBD who were fol­lowed between 2007 and 2025, and underwent a total of 2,352 colonoscopies. Demographic and clinical data, endoscopic findings, and histological results were analyzed. Risk factors for dysplasia and carcinoma were assessed using a time-dependent Cox regression model. Results: Dysplasia was detected in 76 patients (20.8%), with a neoplasia detection rate of 9.18%. A total of 216 dysplastic lesions were identified (50.9% from polypectomies and 49.1% from bio­psies). Adenocarcinoma was dia­gnosed in 13 patients (3.6%). Statistically significant risk factors included higher age (HR = 1.03; P = 0.008), bio­logic therapy (HR = 2.48; P = 0.029), and dis­ease duration (P < 0.001). The Mayo endoscopic subscore showed a positive trend toward significance (HR = 1.27; P = 0.051). Conclusion: Our study confirms the high risk of colorectal neoplasia in patients with PSC-IBD, particularly in older individuals, those with longer dis­ease duration, and those receiving bio­logic therapy. It highlights the importance of annual surveillance colonoscopies with both targeted and random bio­psies.