# Frequency and impact of repeat colonoscopy as a treat‐to‐target approach in pediatric inflammatory bowel disease

## TL;DR

This study shows that most pediatric inflammatory bowel disease patients undergo repeat colonoscopies to assess healing, leading to frequent treatment changes.

## Contribution

The study provides empirical evidence on the frequency and impact of repeat colonoscopies in guiding treatment decisions in pediatric IBD.

## Key findings

- Over 90% of pediatric IBD patients underwent repeat colonoscopy within 2 years of diagnosis.
- Nearly 40% of patients had treatment modifications after colonoscopy, including medication escalation and de-escalation.
- Only 3% of patients or families refused repeat colonoscopy despite perceived barriers.

## Abstract

Endoscopic healing (EH) is a treatment target in inflammatory bowel disease (IBD). However, adherence to repeat colonoscopy (RC) for EH assessment in pediatrics remains variable. We aimed to evaluate the frequency and timing of RC after diagnosis and its impact on treatment decisions at a large pediatric IBD center.

We conducted a retrospective cohort study of pediatric patients diagnosed with IBD January 2019 to December 2021 using an internal patient database and electronic medical records. Data included demographics, treatments, timing of RC, reasons for no RC (if not completed), and therapy modifications following RC (medication escalations and de‐escalations). The study took place within the context of an institutional quality improvement project aimed at improving RC rates within 15 months of diagnosis.

Of 325 patients diagnosed via baseline colonoscopy during the study interval, 91% underwent RC; 8% within 6 months due to inadequate primary therapy response, 67% between 7 and 15 months, and 16% beyond 15 months. Among the 272 patients with a RC > 6 months postdiagnosis, therapy modification occurred in 39% (107/272), with 81% (87/107) requiring medication escalation, 16% (17/107) medication de‐escalation, and 3% (3/107) surgical intervention. Only 3% of patients declined a RC due to patient/family preference.

Adherence to the treat‐to‐target strategy recommending RC within 15 months of diagnosis was high, exceeding previously reported pediatric rates. Only 3% of patients/families declined RC despite this being a perceived barrier toward assessment of EH. Therapy adjustments post‐RC were frequent, underscoring the importance of mucosal assessment in guiding treatment optimization.

Endoscopic healing is a key treatment target in pediatric inflammatory bowel disease (IBD).Repeat colonoscopy (RC) is recommended to assess endoscopic healing but adherence is variable.Barriers to RC include patient reluctance and provider practice variation.

Endoscopic healing is a key treatment target in pediatric inflammatory bowel disease (IBD).

Repeat colonoscopy (RC) is recommended to assess endoscopic healing but adherence is variable.

Barriers to RC include patient reluctance and provider practice variation.

Over 90% of patients at a large pediatric center completed a RC within 2 years of diagnosis.Nearly 40% of patients had treatment changes following colonoscopy, most commonly therapy escalation but also medication de‐escalation in select patients.Patient or family refusal to complete RC was very low, with only 3% declining endoscopic reassessment.Standardized care pathways may enhance adherence to treat‐to‐target strategies in pediatric IBD.

Over 90% of patients at a large pediatric center completed a RC within 2 years of diagnosis.

Nearly 40% of patients had treatment changes following colonoscopy, most commonly therapy escalation but also medication de‐escalation in select patients.

Patient or family refusal to complete RC was very low, with only 3% declining endoscopic reassessment.

Standardized care pathways may enhance adherence to treat‐to‐target strategies in pediatric IBD.