This article is more than 5 years old. Information may no longer be current.
Indefinite dysplasia in IBD increases advanced neoplasia risk
Click Here to Manage Email Alerts
For patients with inflammatory bowel disease who were undergoing surveillance for colorectal neoplasia, indefinite dysplasia was associated with an increased risk for the development of advanced colorectal neoplasia, according to study results.
If validated, Steven H. Itzkowitz, MD, of the Icahn School of Medicine at Mount Sinai, and colleagues wrote that guidelines for colorectal neoplasia surveillance might need revision. Although there is an established link between low-grade dysplasia and advanced colorectal neoplasia — defined as high-grade dysplasia or colorectal cancer — the clinical significance of indefinite dysplasia is much less clear.
“In the modern era characterized by a vast expansion in medical options to control inflammation, and endoscopic advancements to enhance mucosal visualization, defining the natural history of [indefinite dysplasia] is fundamental to optimizing evidenced-based clinical algorithms for surveillance in IBD,” Itzkowitz and colleagues wrote.
Researchers conducted a retrospective cohort analysis comprising 492 patients with colonic IBD for 8 or more years, or concomitant primary sclerosing cholangitis, with no history of advanced colorectal neoplasia or colectomy, who underwent colorectal neoplasia surveillance from 2001 to 2017. They collected data on the development of advanced colorectal neoplasia and identified factors associated with its development.
During 2,149 person-years of follow-up, 52 patients were diagnosed with indefinite dysplasia with prior or synchronous low-grade dysplasia. Compared with patients without dysplasia, patients with indefinite dysplasia had a higher risk for advanced colorectal neoplasia (adjusted HR = 6.85; 95% CI, 1.78–26.4) and colorectal neoplasia (aHR = 3.25; 95% CI, 1.5–7.05). However, they were not at higher risk for colectomy.
The incidence rates of advanced colorectal neoplasia increased from 0.4% per patient-year after a diagnosis of no dysplasia, 3.1% per patient-year after a diagnosis of indefinite dysplasia and 8.4% per patient-year after a diagnosis of low-grade dysplasia.
Itzkowitz and colleagues wrote that current guidelines do not offer clear recommendations for the management of indefinite dysplasia.
“In the future, [indefinite dysplasia] should be considered in evidence-based risk-stratification models to guide optimal [colorectal neoplasia] surveillance and management among patients with IBD,” they wrote. “Such models would allow for effective surveillance, and thereby limit the physical and psychological burden on patients, as well as societal health care costs.” – by Alex Young
Disclosures: Itzkowitz reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
Read more about
Click Here to Manage Email Alerts