Endoscopic resection for non-polypoid dysplasia in inflammatory bowel disease: a systematic review protocol

IntroductionNon-polypoid low-grade dysplasia in inflammatory bowel disease is associated with a medium increased risk of colorectal cancer, while treatment recommendations remain controversial. We aim to evaluate the efficacy and safety of endoscopic treatment for non-polypoid dysplasia in patients with inflammatory bowel disease.Methods and analysisMedline, Embase, Cochrane Library, Scopus, Web of Science and clinical trials registry from database inception to the search date will be used to retrieve eligible studies. Studies that report the curative resection rate or any of other secondary outcomes of endoscopic treatment in patients with non-polypoid dysplasia in inflammatory bowel disease will be included in the analysis. We will conduct quantitative synthesis if the eligible studies are homogeneous judging from clinical and methodological perspectives.Ethics and disseminationEthical approval for this study was waived by the Ethics Committee of Peking Union Medical College Hospital because there are no individual data involved in the analysis and all the combined results will be retrieved from study-level data. We plan to disseminate results through peer-reviewed journals or conference abstracts.PROSPERO registration numberCRD42019120413.

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Increased risk of high-grade dysplasia and colorectal cancer in inflammatory bowel disease patients with recurrent low-grade dysplasia

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.12.041 ◽

2020 ◽

Vol 91 (6) ◽

pp. 1334-1342.e1 ◽

Cited By ~ 2

Author(s):

Michiel E. de Jong ◽

Heleen Kanne ◽

Loes H.C. Nissen ◽

Joost P.H. Drenth ◽

Lauranne A.A. P. Derikx ◽

...

Keyword(s):

Colorectal Cancer ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Increased Risk ◽

Inflammatory Bowel ◽

Low Grade Dysplasia

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Acute Coronary Syndromes and Inflammatory Bowel Disease: The Gut–Heart Connection

Journal of Clinical Medicine ◽

10.3390/jcm10204710 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4710

Author(s):

Ayman Jaaouani ◽

Abdulrahman Ismaiel ◽

Stefan-Lucian Popa ◽

Dan L. Dumitrascu

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Acute Coronary Syndromes ◽

Observational Studies ◽

Common Ground ◽

Cochrane Library ◽

Oral Contraceptive Pills ◽

Increased Risk ◽

Coronary Syndromes ◽

Inflammatory Bowel

(1) Background: Inflammatory bowel disease (IBD) induces a process of systemic inflammation, sharing common ground with acute coronary syndromes (ACS). Growing evidence points towards a possible association between IBD and an increased risk of ACS, yet the topic is still inconclusive. Therefore, we conducted a systematic review aiming to clarify these gaps in the evidence. (2) Methods: We conducted a systematic search on EMBASE, Cochrane Library, and PubMed, identifying observational studies published prior to November 2020. The diagnosis of IBD was confirmed via histopathology or codes. Full articles that fulfilled our criteria were included. Quality assessment was performed using the Newcastle–Ottawa scale (NOS). (3) Results: We included twenty observational studies with a total population of ~132 million subjects. Fifteen studies reported a significant association between ACS and IBD, while the remaining five studies reported no increase in ACS risk in IBD patients. (4) Conclusions: ACS risk in IBD patients is related to hospitalizations, acute active flares, periods of active disease, and complications, with a risk reduction during remission. Interestingly, a general increase in ACS risk was reported in younger IBD patients. The role of corticosteroids and oral contraceptive pills in increasing the ACS risk of IBD patients should be investigated.

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Mo1845 – Increased Risk of Advanced Neoplasia in Inflammatory Bowel Disease Patients with Recurrent Low-Grade Dysplasia

Gastroenterology ◽

10.1016/s0016-5085(19)39112-7 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-859

Author(s):

Michiel E. de Jong ◽

Heleen Kanne ◽

Loes Nissen ◽

Iris D. Nagtegaal ◽

Joost Drenth ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Low Grade ◽

Advanced Neoplasia ◽

Increased Risk ◽

Inflammatory Bowel ◽

Low Grade Dysplasia

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DOP72 Increased risk of advanced neoplasia in inflammatory bowel disease patients with recurrent low-grade dysplasia

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjy222.106 ◽

2019 ◽

Vol 13 (Supplement_1) ◽

pp. S073-S074

Author(s):

M de Jong ◽

H Kanne ◽

L Nissen ◽

I Nagtegaal ◽

J Drenth ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Low Grade ◽

Advanced Neoplasia ◽

Increased Risk ◽

Inflammatory Bowel ◽

Low Grade Dysplasia

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A164 PATTERNS IN MEDICAL THERAPY AND CLINICAL OUTCOMES IN PATIENTS WITH CONCOMITANT INFLAMMATORY BOWEL DISEASE AND PRIMARY SCLEROSING CHOLANGITIS: A SINGLE CENTRE RETROSPECTIVE ANALYSIS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.162 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 173-174

Author(s):

K Donaldson ◽

R A Mitchell ◽

R A Enns ◽

B Bressler ◽

G Rosenfeld ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Primary Sclerosing Cholangitis ◽

Medical Therapy ◽

Bowel Disease ◽

Sclerosing Cholangitis ◽

Adverse Outcomes ◽

Low Grade ◽

Strict Adherence ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) in patients with primary sclerosing cholangitis (PSC) is characterized by pancolitis with rectal sparing and is associated with an increased risk of colorectal and biliary malignancies. Currently, pharmacologic management of IBD in the setting of PSC is the same as in IBD alone. Aims To assess patterns in medical therapy, and incidence of adverse outcomes in patients with concomitant IBD and PSC. Methods A retrospective review was conducted on all PSC-IBD patients followed between January 2010 and June 2018. The Endoscopic Mayo Score was used to grade IBD severity in PSC-ulcerative colitis (UC). Results 69 patients were identified, 44 (63.8%) were male. The mean ages of IBD and PSC diagnosis were 28.6 (SD 14.9) and 37.0 (SD 18.9) years, respectively. The median length of follow up was 12 (range 2–49) years. 52 (75.4%) patients had UC, and 17 (24.6%) had Crohn’s disease (CD). 28 (87.5%) PSC-UC patients had pancolitis, and 4 (12.5 %) had proctitis. Among those with pancolitis, 8 (28.6%) had relative rectal sparing. 4 (14.3%) patients had more severe inflammation proximally, whereas only 1 (3.6%) had more severe distal inflammation. 23 (82.1%) patients had the same degree of inflammation throughout. 14 (93.3%) PSC-CD patients had colitis/ileocolitis and 1 (6.7%) had ileitis. Among those with PSC-UC, 16 (50.0%), 12 (37.5%), and 4 (12.5%) patients had grade 1, 2, and 3 disease, respectively. 62 (89.9%) PSC-IBD patients were treated with aminosalicylates, and 26 (37.7%) with biologics at some point in their IBD course. 26 (37.7%) were treated with aminosalicylates alone. 4 (5.8%) did not require any IBD therapy. Cholangiocarcinoma, colorectal cancer, and gallbladder cancer developed in 8 (11.6%), 1 (1.4%), and 1 (1.4%) PSC-IBD patients, respectively. 16 (23.2%) patients required partial or total colectomy. Indication for surgery was inflammation or stenosis, dysplasia, and neoplasia in 13 (81.3%), 2 (12.5%), and 1 (6.3%) patients, respectively. Conclusions The majority of this cohort had UC with mild disease activity. Pancolitis was common, with frequent rectal sparing and more severe right-sided inflammation. Despite the predominance of low-grade colitis, a large portion of patients required treatment with biologics. The incidence of adverse outcomes underscores the need for strict adherence to recommended surveillance practices. Low grade endoscopic activity, typical of the quiescent IBD course in PSC-IBD, may mask low grade histologic inflammation, which in turn may contribute to the increased risk of colonic neoplasia. Further studies are needed to determine the best management strategy for IBD in patients with PSC. Funding Agencies None

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Serrated Lesions in Inflammatory Bowel Disease: Genotype-Phenotype Correlation

International Journal of Surgical Pathology ◽

10.1177/1066896920963798 ◽

2020 ◽

pp. 106689692096379

Author(s):

Iva Brcic ◽

Heather Dawson ◽

Hans Peter Gröchenig ◽

Christoph Högenauer ◽

Karl Kashofer

Keyword(s):

Inflammatory Bowel Disease ◽

Molecular Analysis ◽

Bowel Disease ◽

Low Grade ◽

Right Colon ◽

Kras Mutations ◽

Increased Risk ◽

Serrated Lesions ◽

Inflammatory Bowel ◽

The Right

Background Patients with inflammatory bowel disease (IBD) and hyperplastic/serrated polyposis have an increased risk of colorectal cancer. The aim of our study was to elucidate the nature of serrated lesions in IBD patients. Materials and Methods Sixty-five lesions with serrated morphology were analyzed in 39 adult IBD patients. Lesions were classified according to the WHO 2019 criteria or regarded as reactive, and molecular analysis was performed. Results 82.1% of patients had ulcerative colitis, 17.9% had Crohn’s disease; 51.3% were female, and the mean age was 54.5 years. The duration of IBD varied significantly (16.7 ± 11.4 years). Endoscopy showed polypoid lesions in 80.3%; the size ranged from 2 to 20 mm. A total of 21.6% of the lesions were located in the right colon. Five lesions were classified as inflammatory pseudopolyps, 28 as hyperplastic polyp, 21 and 2 as sessile serrated lesion without and with dysplasia, respectively, and 9 as traditional serrated adenoma with low-grade dysplasia. Analysis of all true serrated lesions revealed 31 mutations in KRAS and 32 in BRAF gene. No mutations were identified in inflammatory pseudopolyps. In the right colon BRAF mutations were more frequent than KRAS (16 vs 3), while KRAS mutations prevailed on the left side (28 vs 16, P < .001). One patient with traditional serrated adenomas progressed to an adenocarcinoma after 61 months. Conclusion The molecular analysis could help discriminate true serrated lesions (IBD-associated or not) from reactive pseudopolyps with serrated/hyperplastic epithelial change. These should help in more accurate classification of serrated lesions.

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Worldwide Incidence of Colorectal Cancer, Leukemia, and Lymphoma in Inflammatory Bowel Disease: An Updated Systematic Review and Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2016/1632439 ◽

2016 ◽

Vol 2016 ◽

pp. 1-18 ◽

Cited By ~ 7

Author(s):

Chelle L. Wheat ◽

Kindra Clark-Snustad ◽

Beth Devine ◽

David Grembowski ◽

Timothy A. Thornton ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Inflammatory Bowel Disease ◽

Incidence Rate ◽

Bowel Disease ◽

Meta Analysis ◽

Cochrane Library ◽

Increased Risk ◽

Inflammatory Bowel ◽

Substantial Heterogeneity

Background/Aims. Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). In addition, there may be an association between leukemia and lymphoma and IBD. We conducted a systematic review and meta-analysis of the IBD literature to estimate the incidence of CRC, leukemia, and lymphoma in adult IBD patients.Methods. Studies were identified by a literature search of PubMed, Cochrane Library, Medline, Web of Science, Scopus, EMBASE, and ProQuest Dissertations and Theses. Pooled incidence rates (per 100,000 person-years [py]) were calculated through use of a random effects model, unless substantial heterogeneity prevented pooling of estimates. Several stratified analyses and metaregression were performed to explore potential study heterogeneity and bias.Results. Thirty-six articles fulfilled the inclusion criteria. For CRC, the pooled incidence rate in CD was 53.3/100,000 py (95% CI 46.3–60.3/100,000). The incidence of leukemia was 1.5/100,000 py (95% CI −0.06–3.0/100,000) in IBD, 0.3/100,000 py (95% CI −1.0–1.6/100,000) in CD, and 13.0/100,000 py (95% CI 5.8–20.3/100,000) in UC. For lymphoma, the pooled incidence rate in CD was 0.8/100,000 py (95% CI −0.4–2.1/100,000). Substantial heterogeneity prevented the pooling of other incidence estimates.Conclusion. The incidence of CRC, leukemia, and lymphoma in IBD is low.

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Dysplasia Surveillance in Inflammatory Bowel Disease: A Cohort Study

GE Portuguese Journal of Gastroenterology ◽

10.1159/000510728 ◽

2020 ◽

pp. 1-9

Author(s):

Sofia Saraiva ◽

Isadora Rosa ◽

Joana Moleiro ◽

João Pereira da Silva ◽

Ricardo Fonseca ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Cohort Study ◽

Bowel Disease ◽

Univariate Analysis ◽

Surveillance Program ◽

Low Grade ◽

Increased Risk ◽

Surveillance Programs ◽

History Of ◽

Inflammatory Bowel

Introduction: Patients with colonic inflammatory bowel disease (IBD) are at an increased risk for colorectal cancer (CRC), whereby surveillance colonoscopy is recommended. Aim: To study the clinical and endoscopic variables associated with dysplasia in IBD patients. Methods: A cohort study was conducted on IBD patients who were part of a colonoscopy surveillance program between 2011 and 2016. Results: 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 (p = 0.006). Upon univariate analysis, dysplasia was significantly associated with the type of IBD, the performance of random biopsies, and CE (p = 0.016/0.009/0.05, respectively). On multivariate analysis, dysplasia was associated with duration of disease. Conclusion: 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.

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