Risk of Development of More-advanced Lesions in Patients With Inflammatory Bowel Diseases and Dysplasia

Abstract

BACKGROUND & AIMS: Patients with inflammatory bowel diseases (IBD) have increased risks of dysplasia and colitisassociated cancer (CAC). We evaluated the risk of development of high-grade dysplasia (HGD) or CAC after diagnosis of dysplasia using data from a national cohort of patients with IBD. METHODS: We performed a multicenter retrospective analysis of data collected from 7 tertiary referral regional or academic centers in Belgium. In searches of IBD pathology databases, we identified 813 lesions (616 low-grade dysplasias [LGDs], 64 high-grade dysplasias [HGDs], and 133 CACs) in 410 patients with IBD: 299 had dysplasia (73%) and 111 had CAC (27%). The primary aim was to determine the risk of more-advanced lesions after diagnosis of LGD or HGD. RESULTS: Of the 287 patients with LGD, 21 (7%) developed more-advanced lesions (HGD or CAC) after a median time period of 86 months (interquartile range, 34-214). Of the 28 patients with HGD, 4 (14%) developed CAC after a median time period of 180 months (interquartile range, 23-444). The overall cumulative incidence of CAC at 10 years after an initial diagnosis of HGD was 24.3% and after an initial diagnosis of LGD was 8.5% (P < .05). Metachronous lesions, non-polypoid lesions, and colonic stricture were associated with risk of occurrence of more-advanced lesions after LGD (P < .05). Of the 630 dysplastic lesions identified during endoscopy, 545 (86%) were removed during the same procedure or during a follow-up endoscopy or by surgery. Of 111 patients with CAC, 95 (86%) did not have prior detection of dysplasia and 64 of these 95 patients (67%) developed CAC outside of the screening or surveillance period recommended by the European Crohn's and Colitis Organisation. CONCLUSIONS: In an analysis of pathology data from 7 medical centers in Belgium, we found a low rate of detection of more-advanced lesions following detection of LGD or HGD-taking into account that most of the lesions were removed. Main risk factors for development of more-advanced lesions after LGD were metachronous lesions, non-polypoid lesions, and colon strictures.

Systematic review with meta‐analysis: IBD‐associated colonic dysplasia prognosis in the videoendoscopic era (1990 to present)

“…The strength of this systematic review of videoendoscopic era studies is that it has attempted to clarify the risk of dysplasia progression to advanced neoplasia and specifically the risk of metachronous advanced neoplasia after endoscopic resection of colitis‐associated dysplasia in the videoendoscopic era. In addition, this review has identified a further 20 studies not included in Fumery et al's meta‐analysis 31,33‐38,40‐46,51‐54,56,57 . The wide variation in outcomes demonstrated by our systematic review may be explained by a number of factors.…”

Issue Highlights

“…of IND and the need for close surveillance of these patients to facilitate early identification of dysplastic lesions of a higher grade. See related article by Cremer et al 6 This article is highlighted by an editorial by Oriana M. Damas and Maria T. Abreu. 7 See page 1518.…”

Interpreting post-colonoscopy colorectal cancer rates in inflammatory bowel disease

“…Better quality colonoscopy and adherence to surveillance guidelines in appropriate people should improve the performance of the test. It has been shown that~70 % of dysplasia detected in IBD patients is endoscopically resectable, and resection reduces the 10-year risk of advanced dysplasia [8]. Therefore, it stands to reason that increased detection and resection should reduce the rate of IBD-related PCCRC.…”