OP036 Long-term risk of advanced neoplasia after colonic low-grade dysplasia in patients with inflammatory bowel disease: a nationwide cohort study

Jong, Michiel de; Tilburg, S van; Nissen, Loes H C; Kievit, Wietske; Nagtegaal, I; Hoentjen, Frank; Derikx, L.C.

doi:10.1093/ecco-jcc/jjx180.035

Cited by 3 publications

(2 citation statements)

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“…9 Another nationwide cohort of approximately 4,300 IBD patients with LGD reported a cumulative incidence of advanced neoplasia of 14.4% after 10 years. 10 A recent meta-analysis reported a pooled multivariable hazard ratio (HR) of four studies of 3.67 (95% confidence interval [CI], 2.2–6.1) for the development of CRC given prior diagnosis of LGD. 11 Because of this increased risk for development of CRC, most experts recommend considering total colectomy for IBD patients with HGD or multifocal LGD.…”

Section: Management Of Dysplasia In Ibdmentioning

confidence: 99%

Management of Dysplasia in Inflammatory Bowel Disease

Rubens

Smith

2023

Clin Colon Rectal Surg

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Given the chronic nature of mucosal inflammation present in patients with inflammatory bowel disease (IBD), there is a high risk of dysplastic lesions progressing to cancer, in addition to a high risk of synchronous and/or metachronous cancers developing in those diagnosed with dysplasia. Due to this, consensus guidelines recommend regular surveillance. When visible dysplasia is encountered, options include endoscopic or surgical resection depending on characteristics of the lesion. Advancements in endoscopic tools increasingly allow for endoscopic removal when appropriate. Invisible dysplasia discovered on random biopsy should prompt referral to physicians who specialize in IBD. While surgical resection with proctocolectomy significantly decreases the risk of colorectal cancer, the risk must be balanced against the morbidity of surgery and quality-of-life concerns. Management of dysplasia in IBD patients requires complex decision-making that requires balance of patient values and goals of care with cancer-related risk factors.

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Section: Management Of Dysplasia In Ibdmentioning

confidence: 99%

Management of Dysplasia in Inflammatory Bowel Disease

Rubens

Smith

2023

Clin Colon Rectal Surg

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“…Incidence of CAC associated with LGD or HGD in patients with IBD, therefore, is of special importance in management of these patients. Currently, the reported risk of CAC associated with LGD or HGD in patients with IBD varies greatly between published studies and cannot be defined precisely, although estimates for progression from LGD to a more advanced neoplasia range from 20 % to 30 % 9 10 11 . This variation may be partly due to the use of data that predate videoendoscopy and follow-up recommendations about patient risk factors that are based on data taken without high-definition endoscopies or chromoendoscopy surveillance.…”

Section: Introductionmentioning

confidence: 99%

Low risk of new dysplastic lesions in an inflammatory bowel disease population study with dye chromoendoscopy

et al. 2023

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Background: We are yet to determine the rates of new dysplastic lesions or cancer progression after first dye chromoendoscopy in the era of high-definition endoscopy Aim and Methods: We developed a multicenter, population-based, retrospective cohort from 7 hospitals in Spain. Patients with inflammatory bowel disease and fully resected (R0) dysplastic colon lesions in surveillance with high-definition dye-based chromoendoscopy were sequentially enrolled between February 2011 and June 2017, with a minimum endoscopic follow-up of 36 months. The aim was to assess the incidence of developing more advanced metachronous neoplasia by analyzing possible associated risk factors. Results: The study sample included 99 patients and 148 index lesions (145 low-grade dysplasia lesions [LGD] and 3 high-grade dysplasia lesions [HGD]) with a mean follow-up of 48.76 months (IQR: 36.34–67.15). The overall incidence for new dysplastic lesions was 0.23 per 100 patient–year, 1.15 per 100 patients at 5 years and 2.29 per 100 patients at 10 years. A history of dysplasia was associated with a higher risk of developing any grade of dysplasia during follow-up (p=0.025), whereas left colon lesions were associated with a lower risk (p=0.043). The incidence of more advanced lesions at 1 year and 10 years was 1% and 14% respectively, with lesion size > 1 cm being a risk factor (p=0.041). One of the eight patients (13%) with HGD lesions developed CRC during follow-up. Conclusions: The risk of dysplasia progressing to advanced neoplasia and, specifically, the risk of new neoplastic lesions after endoscopic resection of colitis-associated dysplasia are both very low

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