P0504Need for better documentation of family history of colorectal cancer to improve implementation of Inflammatory Bowel Disease surveillance guidelines.

Abstract Background Patients with inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). The 2025 British Society of Gastroenterology (BSG) guidelines on IBD surveillance mirror the ECCO guidance which emphasise the need for documentation of first-degree relative (FDR) CRC history before determining surveillance intervals1. This is crucial in low-risk groups, where a positive family history changes the interval from a 10-yearly to a 3-yearly colonoscopy. We investigated existing documentation of family history of CRC and its implication to patients undergoing IBD surveillance. Methods A retrospective study was undertaken at West Middlesex University Hospital, a busy district general hospital in London. Electronic records (endoscopy reports and clinic letters) of all patients (n = 103) undergoing routine IBD surveillance colonoscopy between October 2024 and April 2025 were reviewed. Patients undergoing active CRC investigation or treatment were excluded. Data collected included demographics, disease type and extent, medication, endoscopic surveillance modality and documentation of FDR CRC history. Results Of 103 patients, 76 (74%) had ulcerative colitis (UC), 26 (25%) Crohn’s disease (CD), and 1 (1%) unclassified IBD (IBD-U). Median age was 52 years (IQR 43–64) and disease duration 16 years (IQR 10–23), with 66 male and 37 female. 29% of all patients were on biologics. Surveillance used texture enhanced imaging (TXI) in 73% of patients, dye-based chromoendoscopy in 45% and unspecified modality in 22%. Key demographic and disease characteristics are summarised in Table 1. Family history of CRC was documented in only 11/103 (11%) patients; 4 (36%) had a positive FDR history. Of the 7 with a documented negative family history, 5 (71%) had an additional risk factor (active disease/adenoma/pseudopolyp formation), which necessitated further surveillance. Among the 4 with a positive FDR history, only 2 (50%) were correctly assigned a 3-yearly surveillance interval. The remaining 2 continued on longer intervals despite meeting criteria for high-risk surveillance under BSG guidance. None had yet had repeat colonoscopies. Conclusion Despite the shift towards risk-stratified surveillance, in our experience no record of FDR CRC was found in the vast majority of patients. Compliance with FDR history documentation is a prerequisite for accurate risk stratification and appropriate scheduling of surveillance in low-risk patients. In light of these findings, improved attention to document family history is essential. This could be incorporated at the time of clinic or endoscopic assessment and the use of electronic prompts may be a helpful way to improve compliance, future audit and reduce missed risk stratification opportunities. Reference: 1. East JE, Gordon M, Nigam GB, et al. British Society of Gastroenterology guidelines on colorectal surveillance in inflammatory bowel disease. Gut. Published online April 30, 2025. doi:10.1136/gutjnl-2025-335023 Conflict of interest: Dr. Monem, Enrique: No conflict of interest Johnston, Emma: No conflict of interest Bouri, Sonia: No conflict of interest Mohamed, Zameer: No conflict of interest