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THE RISK OF SYNCHRONOUS COLORECTAL CANCER IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE AND HIGH-GRADE DYSPLASIA

Edgard Medawar 1, Roupen Djinbachian 2, Ioana Popescu Crainic 2, Ali Vedadi 1, Alan N. Barkun 3, Jeffrey McCurdy 1, Peter L Lakatos 3, Daniel von Renteln 2

Affiliations

1 University of Ottawa, Ottawa, Canada

2 Montreal University Hospital Research Center, Montreal, Canada

3 McGill University Health Center, Montreal, Canada

Summary

AI Generated

Patients with inflammatory bowel disease and high-grade dysplasia have twice the odds of synchronous colorectal cancer compared to those with high-grade dysplasia alone, with nearly half having synchronous cancer at diagnosis.

In a retrospective cohort of 37 IBD patients with high-grade dysplasia, 48.6% had synchronous colorectal cancer at index colonoscopy compared to 29.9% of 982 non-IBD patients with high-grade dysplasia (odds ratio 2.22, 95% CI 1.15-4.29).
Among IBD patients with high-grade dysplasia, 43.2% had cancer in the lesion where dysplasia was biopsied and 5.4% had cancer at another location.
Seventy percent of IBD patients with high-grade dysplasia were managed surgically, with 17 of 26 undergoing total colectomy.
All 8 IBD patients with invisible high-grade dysplasia identified on random biopsies underwent total colectomy.
This study is relevant for gastroenterologists managing surveillance and treatment decisions in IBD patients with dysplasia.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

The risk of synchronous colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) and high-grade dysplasia (HGD) is not known.

Aims & Methods

Study aim was to compare the risk of colorectal cancer at index colonoscopy in patients with HGD and IBD to patients with HGD without IBD. We also sought to evaluate the current management of visible HGD and invisible HGD, identified on random biopsies, in IBD. A retrospective cohort study was conducted. Through pathology database search, we identified all 1283 consecutive patients with an endoscopically resected colorectal HGD (biopsy or polypectomy), between 2010 and 2019 at the University of Montreal Hospital Center. We included patients aged 45-75 and excluded patients with polyposis syndromes, a history of CRC or index sigmoidoscopy. Files were reviewed for demographic data, index findings, IBD characteristics, and HGD management. Primary outcome was the risk of synchronous CRC at index colonoscopy in patients with HGD and IBD versus HGD and no IBD. Synchronous CRC was defined as CRC on index or CRC identified on surgery as the underlying lesion from which HGD was biopsied. Secondary outcomes were the proportion of visible and invisible HGD in IBD managed surgically. Continuous and categorical variables were compared using the Student t test, Pearson’s chi-squared test, or Mann-Whitney test. Multivariable logistic regression analysis was performed for the primary outcome.

Results

Overall, 982 patients with HGD without IBD (mean age 63 years; 55% male), and 37 patients with HGD and with IBD (mean age 59 years; 78% male; 62% ulcerative colitis; 38% Crohn’s disease; median time from IBD diagnosis to HGD is 17.0 years, mean 19.9 ± 13.4 years) were eligible based on inclusion and exclusion criteria above. In the HGD without IBD group, 294 patients out of 982 (29.9%) had synchronous CRC, with 260 CRCs found in the lesion where HGD was biopsied (26.5%), and 34 CRCs found in another location (3.5%). In the HGD with IBD group, 18 patients out of 37 (48.6%) had synchronous CRC, with 16 CRCs found in the lesion where HGD was biopsied (43.2%), and 2 CRCs found in another location (5.4%). Patients with HGD and IBD were more likely to have synchronous CRC compared to HGD and no IBD (odds ratio 2.22, 95%CI: 1.15-4.29). Out of 37 patients with IBD and HGD, 26 were managed surgically (70.3%), with 17 undergoing total colectomies, 4 right hemicolectomies, 4 transanal excisions, and 1 low anterior resection. Out of 37 patients with IBD and HGD, 8 had invisible HGD (21.6%) and all underwent total colectomy.

Conclusion

Patients with HGD and IBD are significantly more likely to have synchronous CRC compared to patients with HGD without IBD, with half of patients with HGD and IBD having synchronous CRC. Most patients with IBD and HGD are managed surgically, usually by total colectomy.

Disclosure

None

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

There are always openings (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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