Dysplasia Surveillance in Inflammatory Bowel Disease: A Cohort Study

Abstract

<b><i>Introduction:</i></b> Patients with colonic inflammatory bowel disease (IBD) are at an increased risk for colorectal cancer (CRC), whereby surveillance colonoscopy is recommended. <b><i>Aim:</i></b> To study the clinical and endoscopic variables associated with dysplasia in IBD patients. <b><i>Methods:</i></b> A cohort study was conducted on IBD patients who were part of a colonoscopy surveillance program between 2011 and 2016. <b><i>Results:</i></b> A total of 342 colonoscopies were performed on 162 patients (105 with ulcerative colitis [UC] and 57 with Crohn’s disease). Random biopsies were performed at least once on 81.5% of patients; 33.3% of the patients underwent chromoendoscopy (CE) at least once. Endoscopically resectable lesions were detected in 55 patients (34%), and visible lesions deemed unfit for endoscopic resection were found in 5 patients (3.1%). Overall, 62 dysplastic visible lesions (58 with low-grade dysplasia and 3 with high-grade dysplasia) and 1 adenocarcinoma were found in 34 patients. Dysplasia in random biopsies was present in 3 patients, the yield of random biopsies for dysplasia being 1.85%/patient (3/162), 1.75%/colonoscopy (6/342), and 0.25%/biopsy (9/3,637). Dysplasia detected in random biopsies was significantly associated with a personal history of visible dysplasia (<i>p</i> = 0.006). Upon univariate analysis, dysplasia was significantly associated with the type of IBD, the performance of random biopsies, and CE (<i>p</i> = 0.016/0.009/0.05, respectively). On multivariate analysis, dysplasia was associated with duration of disease. <b><i>Conclusion:</i></b> Our data confirm that patients with long-standing IBD, in particular UC, should be enrolled in dysplasia surveillance programs, and that performing CE and random biopsies seems to help in the detection of colonic neoplastic lesions.

Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology

“…It is also believed that random biopsies should be performed also when, despite the existing recommendations, chromoendoscopy is not possible [160,161].…”

Endoscopic colorectal cancer surveillance in inflammatory bowel disease: Considerations that we must not forget

“…Artificial intelligence (AI) is evolving as a topic of interest in the field of gastrointestinal endoscopy. AI has been used in endoscopic polyp detection; no studies on AI in IBD surveillance have been published so far[ 70 ].…”

Measuring the concordance between endoscopic and histologic inflammation and its effect on IBD-associated dysplasia

“…This has led to continued recommendations for random mucosal sampling for detection of "invisible" dysplasia. [11][12][13][14] Importantly, inflammation at the time of surveillance is also associated with increased findings of dysplasia in random biopsies [15][16][17][18] and development of CRC has been linked to persistent subclinical histologic inflammation. [19][20][21][22][23] Current guidelines endorse endoscopic healing (EH) as an objective therapeutic target, with histologic healing as an adjunctive one [24] and several endoscopic and histologic scoring systems for inflammation have been developed to document mucosal healing with poor correlation or agreement between these scores.…”

“…Some dysplastic lesions may be flat and difficult to visualize, especially when localized within inflamed mucosa. This has led to continued recommendations for random mucosal sampling for detection of "invisible" dysplasia [11,12,13,14]. Importantly, inflammation at the time of surveillance is also associated with increased findings of dysplasia in random biopsies [15,16,17,18] and development of CRC has been linked to persistent subclinical histologic inflammation [19,20,21,22,23].…”