ASSURANCE: a multi-centre practical and systematised approach to colorectal cancer surveillance in patients with inflammatory bowel disease

Introduction: Patients with IBD have an increased risk of colorectal cancer (CRC). ASSURANCE, a user-friendly, online cloud-based software, was developed to simplify CRC risk stratification, facilitate long-term individualized CRC surveillance and collect data on large populations. Since initiation in 2014, ASSURANCE has garnered active participation in 21 hospital centres across Australia, Singapore and Hong Kong. Methods: Data were extracted from the ASSURANCE database. Results: 112 IBD patients completed CRC surveillance assessments comprising 72 (64%) with Ulcerative Colitis (UC), 35 (31%) with Crohn's Disease (CD).Majority of UC patients (97 patients, 78%) were stratified to low and moderate CRC risks (recommended surveillance colonoscopy in 3 and 1 year(s), respectively) with 11 (10%) stratified to high and highest risk levels with recommended surveillance in 6 and 3 months, respectively. Major risk factors included structural changes in 29 patients, previous dysplasia on flat mucosa in 6, family history of CRC in 4, PSC in 4, history of adenomatous polyps in 2. Twenty-two patients have had additional follow-up colonoscopies, 19 of whom were classified to have at least moderate CRC risk; 21 repeat colonoscopies were for CRC surveillance and 1 was an interval colonoscopy; 5 of these were a deviation from the guideline recommendation, 3 due to doctor preference and 2 to patient preference. Two patients with low-grade dysplasia were detected on surveillance colonoscopies, one using white-light high-definition and one chromoendoscopy, confocal and narrow-band imaging. A total of 134 colonoscopies have been performed; 59 (44%) using white-light high-definition, 45 (34%) chromoendoscopy and 18 (13%) narrow-band imaging. In 90 (67%) colonoscopies had <10 random biopsies and in 44 (33%) >10 biopsies. Deviations from recommendations on surveillance colonoscopy occurred in 25 patients; 12 due to patient preference, 11 to doctor preference and other reasons in 2. Conclusions: ASSURANCE is a streamlined practical surveillance tool that has become integrated into clinical care, with systematised follow-up and standardised colonoscopic practice. It also documents surveillance practice. It will allow physician, national and international CRC surveillance practice data and outcomes to be determined.