No Association Between Pseudopolyps and Colorectal Neoplasia in Patients With Inflammatory Bowel Diseases

Mahmoud, Remi; Shah, Shailja C.; Hove, Joren R. ten; Torres, Joana; Mooiweer, Erik; Castañeda, Daniel; Glass, Jason; Elman, Jordan; Kumar, Akash; Axelrad, Jordan E.; Ullman, Thomas; Colombel, Jean–Frédéric; Oldenburg, Bas; Itzkowitz, Steven H.

doi:10.1053/j.gastro.2018.11.067

Cited by 60 publications

(80 citation statements)

References 27 publications

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“…Although the association between pseudopolyps and CRC remains debated, patients with a history of pseudopolyps underwent surveillance colonoscopy according to guidelines at the time of the study 25…”

Section: Discussionmentioning

confidence: 99%

Risk of colorectal cancer in a population-based study 20 years after diagnosis of ulcerative colitis: results from the IBSEN study

Klepp

Brackmann

Cvancarova

et al. 2020

BMJ Open Gastroenterol

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ObjectiveThe association between ulcerative colitis (UC) and colorectal cancer (CRC) is widely accepted, although attenuated risk has been reported in recent years. Colonoscopic surveillance is recommended with intervals based on established clinical risk factors. Nevertheless, a significant number of patients develop interval cancers, indicating the need of improved individualised assessment. In the present study, we evaluated clinical risk factors associated with CRC during a prescheduled follow-up 20 years after diagnosis, the IBSEN study.DesignA population-based inception cohort of patients diagnosed with inflammatory bowel disease from 1 January 1990 until 31 December 1993, prospectively followed at 1, 5, 10 and 20 years after diagnosis. A total of 517 patients with UC were included; 264 (51 %) men; median age at inclusion 37.4 years (4–88).ResultsThe overall incidence of CRC was 1.6% (8/517) at a 20-year follow-up. The total lifetime risk of CRC prior to or after UC diagnosis was 2.3%. (12/517). Patients older than 70 years at diagnosis had a 15-fold higher risk of CRC compared with those diagnosed when younger than 40 years, with HR 15.68 (95% CI: 1.31 to 187.92). Neither sex, first-degree relative with CRC, extent of colitis nor primary sclerosing cholangitis affected the risk of CRC.ConclusionThe risk of CRC in UC was low and comparable with the risk of CRC in the background population of Norway.

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Section: Discussionmentioning

confidence: 99%

Risk of colorectal cancer in a population-based study 20 years after diagnosis of ulcerative colitis: results from the IBSEN study

Klepp

Brackmann

Cvancarova

et al. 2020

BMJ Open Gastroenterol

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“…Most neoplasias detected in each institute after the initial RCT were reportedly sporadic adenomas and were managed by endoscopic removal. Besides, although pathological inflammation has been reported to be a risk factor for CRC in patients with UC [ 33 ], we did not assess pathological inflammation and its association with CRC development. Second, a study recommended random biopsy for patients with PSC [ 11 ], whereas no concurrent PSC cases were found in the present study.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy

Hata

Ishihara

Ajioka

et al. 2020

JCM

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We previously performed a randomized controlled trial (RCT) comparing targeted and random biopsy in neoplasia detection in patients with ulcerative colitis (UC), which showed the short-term effectiveness of targeted biopsy with one-time colonoscopy. In this retrospective cohort study, we investigated the long-term effectiveness of targeted biopsy in tertiary care hospitals, using the follow-up data from patients with UC for ≥ 8 years who had enrolled in the initial RCT. The primary outcome was death from colorectal cancer (CRC). Secondary outcomes were advanced neoplasia (CRC or high-grade dysplasia) and colectomy due to neoplasia after the RCT. We compared these outcomes between target and random groups. Data on 195 of the 221 patients (88.2%) enrolled in the previous RCT were collected from 28 institutions between 2008 and 2019. No patients died of CRC in either group, with a median 8.8-year follow-up demonstrating a robustness for targeted biopsy in terms of CRC death prevention. Advanced neoplasia was detected in four and three patients in the target and random groups, respectively. Colectomy was required due to neoplasia in three patients in each group. The chance of developing CRC in patients with a negative colonoscopy was low, and the targeted biopsy appeared effective in this population. Conversely, patients found with low-grade dysplasia at initial RCT have 10-fold higher risk of progression to high-grade dysplasia and/or CRC. Ten extracolonic malignancies were observed during the follow-up, resulting in four deaths. Panchromoendoscopy was used only in 4.6% and targeted biopsy was only performed in 59.1% of colonoscopies. We recommend targeted biopsy rather than > 33 random biopsies in real-world settings under adequate observation by specialists.

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“…51 Studies have reported a low risk of malignant transformation of pseudopolyps, supporting the practice of not removing pseudopolyps unless there is diagnostic uncertainty or features concerning for malignancy. 51,52 However, if quality colonoscopic surveillance is unable to be performed due to severe pseudopolyposis interfering with visualization, colectomy should be seriously considered. 42 Patient 41 In addition to the elevated risk of CRN, providers who care for patients with IBD and concomitant PSC must also be aware of the elevated risk of hepatobiliary cancers, and ensure appropriate screening/surveillance is similarly achieved.…”

Section: Epidemiologymentioning

confidence: 99%

Diagnosis and management of inflammatory bowel disease-associated neoplasia: considerations in the modern era

Axelrad

Shah

2020

Therap Adv Gastroenterol

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Patients with inflammatory bowel disease (IBD) are at an increased risk of developing intestinal neoplasia—particularly colorectal neoplasia, including dysplasia and colorectal cancer (CRC)—as a primary consequence of chronic inflammation. While the current incidence of CRC in IBD is lower compared with prior decades, due, in large part, to more effective therapies and improved colonoscopic technologies, CRC still accounts for a significant proportion of IBD-related deaths. The focus of this review is on the pathogenesis; epidemiology, including disease- and patient-related risk factors; diagnosis; surveillance; and management of IBD-associated neoplasia.

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No Association Between Pseudopolyps and Colorectal Neoplasia in Patients With Inflammatory Bowel Diseases

Cited by 60 publications

References 27 publications

Risk of colorectal cancer in a population-based study 20 years after diagnosis of ulcerative colitis: results from the IBSEN study

Risk of colorectal cancer in a population-based study 20 years after diagnosis of ulcerative colitis: results from the IBSEN study

Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy

Diagnosis and management of inflammatory bowel disease-associated neoplasia: considerations in the modern era

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