Surveillance colonoscopy in patients with quiescent inflammatory bowel disease is associated with increased post-procedure steroid prescriptions: a national database study

Surveillance colonoscopy reduces colorectal cancer (CRC) risk in inflammatory bowel disease (IBD), but anecdotal evidence suggests a link between surveillance colonoscopy and symptoms flare, which may affect patient compliance with CRC surveillance. We investigated the effects of surveillance colonoscopy in quiescent IBD using a national database to conduct a retrospective, propensity score-matched (PSM) cohort study of 1,717 patients with IBD and 1,717 patients without IBD who underwent colonoscopy. Strict inclusion criteria were used to select patients with quiescent IBD undergoing surveillance colonoscopy. We demonstrated that patients with quiescent IBD prior to colonoscopy received significantly more post-colonoscopy steroid prescriptions compared to matched controls (OR 1.46 [1.20, 1.77], p<0.001). Steroid prescriptions were more likely in patients with IBD at longer follow-up intervals, suggesting a delayed mechanism of onset for post-colonoscopy inflammation. No significant differences between groups were observed for the other outcomes of post-procedure emergency room and hospital visits or enteric infections. Our results suggest a potential risk of symptom exacerbation, evidenced by increased steroid prescriptions, following surveillance colonoscopy. Given that nearly 25% of patients with IBD do not receive surveillance colonoscopy at the recommended intervals, active post-procedure symptoms may be a contributing factor that warrants further investigation.