The first UK-wide analysis of bowel screening for patients with inflammatory bowel disease (IBD) has identified opportunities to improve the early detection of cancer.
The study – the largest of its kind globally – found that checks performed by professionals with regular experience, allowing more time for the procedure, and the use of a special dye to improve visibility were each associated with finding small growths called polyps, which may become cancer.
Experts say the findings provide a starting point for measuring and improving care for those with IBD, and support further investigation into whether more consistent pathways and protected time could lead to better patient outcomes.
People with IBD – such as Crohn's disease or ulcerative colitis – which affects the large bowel have a higher risk of bowel cancer. Regular camera checks, known as endoscopies, can find early changes. These are usually scheduled alongside other hospital procedures, which can make consistent care harder to plan.
Researchers, led by the University of Edinburgh, carried out the first national-scale analysis of UK data on the quality of IBD endoscopies to see how the checks are being delivered and what factors are associated with finding polyps, some of which may be precancerous.
The research team analysed data from the National Endoscopy Database, covering approximately 65 per cent of UK endoscopy units. This included almost 16,000 procedures in 2024 by 4,669 endoscopists, who perform the tests.
They found that fewer than one in five endoscopists performed the checks at least monthly, yet were responsible for carrying out 57 per cent of procedures.
The study provides the first national evidence linking polyp detection with the experience of the person doing the test, the time allowed and use of dye.
Better evidence could ultimately help people with IBD receive more consistent care and improve the chances of finding important changes early, experts say.
The study team highlights that the database did not include laboratory results for removed polyps, so cannot determine whether the differences led to fewer cancers. Further research is needed to find out which changes improve cancer prevention.
The study is published in the Journal of Crohn's and Colitis: https://academic.oup.com/ecco-jcc/article-lookup/doi/10.1093/ecco-jcc/jjag126 [URL will become active after embargo lifts]. The UK-wide collaboration involved clinicians and researchers from NHS organisations and universities across all four nations.
The study's principal investigator, Dr Shahida Din, from the University of Edinburgh's Institute of Genetics and Cancer, said: "IBD cancer checks are important, but unlike organised bowel cancer screening, they do not have the same protected capacity. A small proportion of endoscopists perform most of these checks, and regular experience, more time and use of dye were associated with finding more polyps. Further research should establish whether more consistent pathways and dedicated time improve detection of precancerous changes and, ultimately, patient outcomes."
