Patients with Endoscopically Visible Polypoid Adenomatous Lesions Within the Extent of Ulcerative Colitis Have an Increased Risk of Colorectal Cancer Despite Endoscopic Resection

Abstract

Objectives: Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer (CRC). Few studies have looked at long term outcomes of endoscopically visible adenomatous lesions removed by endoscopic resection in these patients. We aimed to assess the risk of developing CRC in UC patients with adenomatous lesions that develop within the segment of colitis compared to the remainder of an ulcerative colitis cohort. Conclusions: The risk of developing CRC is significantly higher in UC patients with polypoid adenomatous lesions, within the extent of inflammation, despite endoscopic resection. Patients and physicians should take the increased risk into consideration during follow up of these patients.

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

“…Kisiel et al's study using high‐definition chromoendoscopy also showed no progression to cancer over an average follow‐up of a median of 4.5 years 34 . In two studies where chromoendoscopy was not used, there was progression to cancer at a rate of 25.0% (n = 3/12) over a median of 1.7 years 37 and 40.0% (n = 2/5) over a median of 4 years 36 . In the former study high‐definition white light colonoscopy and polypectomy were performed by accredited endoscopists 37 …”

“…Seven studies (five cohort studies and two case series) reported on cancer progression rates after endoscopic resection of polypoid HGD (Table 3). 33‐37,39,40 All of the studies reported on very small numbers of polypoid HGD, and based completeness of resection on endoscopist judgement rather than histological assessment. This was due to difficulty in histological assessment of resection margins as a result of diathermy artefact or piecemeal resection.…”

“…Nine studies (seven cohort studies and two case series) reported on advanced neoplasia progression rates while on surveillance follow‐up after endoscopic resection of the index polypoid LGD (Table 3). 33‐37,40,48,52,53 The majority of these studies included a mixture of LGD and HGD polyps, again making pooled analysis inappropriate. Resection techniques included hot and cold biopsy, cold snare, piecemeal and en bloc endoscopic mucosal resection.…”

“…The average polyp diameters were 15 mm or less. Advanced neoplasia progression rates were reported to be 0.0%‐5.0% at 1 year 33,34,37,40,52,53 and 0%‐23.0% at 5 years 33,34,36,37,40,48,53 . The highest 5‐year advanced neoplasia rate of 23.0% was associated with a study which used high‐definition white light imaging colonoscopy and not chromoendoscopy 37 .…”

Correlation Between Immune Lymphoid Cells and Plasmacytoid Dendritic Cells in Human Colon Cancer

“…Colon cancer is the third most commonly diagnosed cancer worldwide [1][2][3]; furthermore, its incidence has signi cantly increased recently [4] and is expected to further rise by 50% in the next ve years [5]. Epidemiological studies show that the causes of colon cancer are related to environmental, lifestyle, and genetic factors, and that age, intestinal polyps, and ulcerative colitis also represent high-risk factors [6,7]; however, the speci c pathogenesis of colon cancer remains unclear.…”