Serrated Lesions in Inflammatory Bowel Disease: Genotype-Phenotype Correlation

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.

scholarly journals P307 Colorectal neoplasia risk in patients with inflammatory bowel disease and serrated lesions

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S307-S308
Author(s):  
M De Jong ◽  
S Vos ◽  
I Nagtegaal ◽  
Y van Herwaarden ◽  
L Derikx ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Colorectal Neoplasia ◽  
Classification Systems ◽  
Advanced Neoplasia ◽  
Increased Risk ◽  
Serrated Lesions ◽  
Inflammatory Bowel ◽  
Serrated Lesion ◽  
The Impact

Abstract Background The presence of serrated lesions (SLs) is an established risk factor for colorectal neoplasia development in the general population. However, the impact of SLs on the colorectal neoplasia risk in inflammatory bowel disease (IBD) patients is unknown. In addition, SLs might have been misclassified in IBD patients in the past, in part due to revisions of classification systems. Presently, SLs are categorised as hyperplastic lesions, sessile SLs, and traditional serrated adenomas. We aimed (1) to compare the colorectal neoplasia risk in IBD patients with SLs vs. IBD patients without SLs, and 2) to study the subclassification of SLs in IBD patients before and after histopathological review by two expert gastrointestinal pathologists. Methods We identified all IBD patients with colonic SLs from 1996 to 2019 in a tertiary referral centre using the local histopathology database. Patients with neoplasia prior to SL diagnosis were excluded. Clinical data from patients’ charts were retrieved until June 2019. A subgroup of 135 SLs was reviewed by two pathologists. The log-rank analysis was used to compare the cumulative (advanced) neoplasia incidence in IBD patients with SL vs. IBD patients without SL undergoing surveillance in the same time period. Patients were censored at the end of surveillance or at colectomy. Results We identified 376 SLs in 204 IBD patients (61.9% ulcerative colitis (UC)). In the original reports, 91.9% was classified as a hyperplastic lesion. After histopathological review, 120/136 (88%) of the SLs were confirmed (16 were no SL). Of the 120 confirmed SLs, 62.2% was classified as a sessile SL, 37.8% as a hyperplastic lesion, and 0.8% as a traditional serrated adenoma. The mean time from IBD diagnosis to the first serrated lesion was 14.3 ( ± 12.3) years. A total of 41/204 (20.0%) of patients developed neoplasia (3 CRC, 3 HGD, and 35 LGD; including 2 HGD and 17 LGD at the moment of serrated lesion detection). In the 304 patients without SL (52.6% UC), 63 developed neoplasia (20.7%; 8 CRC, 5 HGD and 50 LGD). Patients who received follow-up colonoscopies after SL (n = 127) had an increased cumulative risk of neoplasia (p &lt; 0.01), but no increased risk of advanced neoplasia (p = 0.50) compared with the group of IBD patients without SL (Figure 1). Conclusion The presence of SLs in IBD patients was associated with a relatively high risk of synchronous colorectal neoplasia as well as an increased risk of subsequent neoplasia, although not with an increased risk of advanced neoplasia. Histopathological review confirmed the SL diagnosis in the majority of lesions, although a large proportion of the hyperplastic lesions was reclassified as a sessile SL.

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

2020 ◽  
Vol 91 (6) ◽  
pp. 1334-1342.e1 ◽  
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

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

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

A Prospective Comparison of 99mTc-Labeled Polyclonal Human Immunoglobulin and 111In Granulocytes for Localization of Inflammatory Bowel Disease

1992 ◽  
Vol 33 (2) ◽  
pp. 140-144 ◽  
Author(s):  
J.-W. Arndt ◽  
Veer A. van der Sluys ◽  
D. Blok ◽  
G. Griffioen ◽  
H. W. Verspaget ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Intestinal Inflammation ◽  
Right Colon ◽  
Prospective Comparison ◽  
Intestinal Segments ◽  
Inflammatory Bowel ◽  
Low Sensitivity ◽  
The Right ◽  
Polyclonal Human Immunoglobulin

There is a need for an easily prepared radiopharmaceutical agent for the detection of inflammation and infection. In a group of 14 patients with inflammatory bowel disease (IBD), the detection of actively involved intestinal segments by nonspecific human polyclonal immunoglobulin (IgG) labeled with 99mTc was compared with that of 111In granulocytes. To determine the specificity of 99mTc-IgG scintigraphy, 8 control patients without clinical indications of intestinal inflammation were examined. 99mTc-IgG was found in the left colon in 8 and in the right colon in 7 of the 8 controls 4 hours after the injection. At that time of scintigraphy only 4 IBD patients exhibited a more intense accumulation at the site of the intestinal segments with active disease. In contrast, in a randomized comparison with 111In granulocytes scintigraphy was positive in 11 patients with the latter technique. Moreover, fewer diseased segments were seen in the 4 patients with positive 99mTc-IgG scintigraphy (6 versus 12 with 111In granulocytes). In view of the low sensitivity and specificity, it is concluded that 99mTc-IgG is not suitable for the scintigraphic staging of IBD patients.

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

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

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

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

scholarly journals DOP37 Neoplastic lesions outside diseased area in inflammatory bowel disease patients: A national cohort study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S074-S075
Author(s):  
A Cremer ◽  
P Demetter ◽  
M De Vos ◽  
J F Rahier ◽  
F Baert ◽  
...  
Keyword(s):  
Low Grade ◽  
Right Colon ◽  
Disease Area ◽  
Surgical Specimen ◽  
Increased Risk ◽  
Neoplastic Lesions ◽  
National Cohort ◽  
Inflammatory Bowel ◽  
The Right

Abstract Background Patients with inflammatory bowel diseases (IBD) are at increased risk of dysplasia and colitis-associated cancer (CAC). The presentation of (pre)neoplastic lesions (low-grade dysplasia (LGD), high-grade dysplasia (HGD) or colorectal cancer (CRC) is reported to vary depending if the lesions are located inside disease area (IDA) or outside diseased area (ODA). The primary aim was to analyse the characteristics and prognostic of IDA compared with ODA neoplastic lesions in a large cohort of IBD patients. Methods We performed a multicentre retrospective pathological data collection from 7 tertiary referral regional or academic IBD centres in Belgium. Clinical, endoscopic and pathological data were retrieved through retrospective electronic chart review. From the IBD pathology databases, 1183 colorectal lesions were identified in 541 IBD patients: 415 developed dysplasia (77%) and 126 CRC (23%) during their follow-up. Biopsies and surgical specimen were centrally reviewed by an expert IBD pathologist to confirm the diagnosis of dysplasia and/or CRC. Results Demographic and clinical variables of the study population are summarised in Table 1. More patients with IDA lesions had HGD (9%) or CAC (27%) during their follow-up compared with the group of patients with ODA lesions (3% of HGD and 11% of CRC) (p &lt; 0,0001). Mortality was higher in patients with IDA than in those with ODA lesions (p &lt; 0.05). When comparing IBD patients with IDA lesions and CAC (=111) to those with ODA lesions and sporadic CRC (n = 15), median age at IBD diagnosis was lower (29 (IQR:22–49) vs. 41(IQR:28–54) years; p = 0.0001). Characteristics of the 1183 neoplastic lesions are summarised in Table 2. IDA lesions were more frequently non-visible, non-polypoid and ≥ 1 cm than ODA lesions (p &lt; 0.0001). ODA sporadic CRC was more frequently located in the right colon compared with IDA CAC (5/16 (31%) vs. 21/133 (16%), p &lt; 0.01). Conclusion Neoplastic lesions outside the diseased area were more likely to be visible, polypoid, &lt; 1cm, in the right colon and diagnosed at endoscopy than inside disease area lesions. A lower prevalence of HGD and Cancer were reported with neoplastic lesions outside the diseased area.

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

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029383
Author(s):  
Yuelun Zhang ◽  
Wei Chen ◽  
Yi Zhao ◽  
Dong Wu
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Endoscopic Treatment ◽  
Cochrane Library ◽  
Low Grade ◽  
College Hospital ◽  
Increased Risk ◽  
Ethical Approval ◽  
Quantitative Synthesis ◽  
Inflammatory Bowel

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.

scholarly journals Dysplasia Surveillance in Inflammatory Bowel Disease: A Cohort Study

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

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