Risk of Development of More-advanced Lesions in Patients With Inflammatory Bowel Diseases and Dysplasia

Anneline Cremer; Pieter Demetter; Martine De Vos; Jean-François Rahier; Filip Baert; Tom Moreels; Elisabeth Macken; Edouard Louis; Liesbeth Ferdinande; Caroline Fervaille; Franceska Dedeurwaerdere; Noela Bletard; Ann Driessen; Gert De Hertogh; Séverine Vermeire; Denis Franchimont; Belgian Inflammatory Bowel Disease Research and Development (BIRD) Group

doi:10.1016/j.cgh.2019.05.062

Risk of Development of More-advanced Lesions in Patients With Inflammatory Bowel Diseases and Dysplasia

Clin Gastroenterol Hepatol. 2020 Jun;18(7):1528-1536.e5. doi: 10.1016/j.cgh.2019.05.062. Epub 2019 Jun 13.

Authors

Anneline Cremer¹, Pieter Demetter², Martine De Vos³, Jean-François Rahier⁴, Filip Baert⁵, Tom Moreels⁶, Elisabeth Macken⁶, Edouard Louis⁷, Liesbeth Ferdinande⁸, Caroline Fervaille⁹, Franceska Dedeurwaerdere¹⁰, Noela Bletard¹¹, Ann Driessen¹², Gert De Hertogh¹³, Séverine Vermeire¹⁴, Denis Franchimont¹⁵; Belgian Inflammatory Bowel Disease Research and Development (BIRD) Group

Affiliations

¹ Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium. Electronic address: anneline.cremer@erasme.ulb.ac.be.
² Department of Pathology, Erasme University Hospital, Brussels, Belgium.
³ Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.
⁴ Department of Gastroenterology, University Hospital Mont-Godinne, Yvoir, Belgium.
⁵ Department of Gastroenterology, Academisch Ziekenhuis Delta, Roeselare, Belgium.
⁶ Department of Gastroenterology, University Hospital Antwerp, Edegem, Belgium.
⁷ Department of Gastroenterology, University Hospital Liège, Liège, Belgium.
⁸ Department of Pathology, University Hospital Ghent, Ghent, Belgium.
⁹ Department of Pathology, University Hospital Mont-Godinne, Yvoir, Belgium.
¹⁰ Department of Pathology, Academisch Ziekenhuis Delta, Roeselare, Belgium.
¹¹ Department of Pathology, University Hospital Liège, Liège, Belgium.
¹² Department of Pathology, University Hospital Antwerp, University Antwerp, Edegem, Belgium.
¹³ Department of Pathology, University Hospital Leuven, Leuven, Belgium.
¹⁴ Department of Gastroenterology, University Hospital Leuven, Leuven, Belgium.
¹⁵ Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium.

PMID: 31202983
DOI: 10.1016/j.cgh.2019.05.062

Abstract

Background & aims: Patients with inflammatory bowel diseases (IBD) have increased risks of dysplasia and colitis-associated cancer (CAC). We evaluated the risk of development of high-grade dysplasia (HGD) or CAC after diagnosis of dysplasia using data from a national cohort of patients with IBD.

Methods: We performed a multicenter retrospective analysis of data collected from 7 tertiary referral regional or academic centers in Belgium. In searches of IBD pathology databases, we identified 813 lesions (616 low-grade dysplasias [LGDs], 64 high-grade dysplasias [HGDs], and 133 CACs) in 410 patients with IBD: 299 had dysplasia (73%) and 111 had CAC (27%). The primary aim was to determine the risk of more-advanced lesions after diagnosis of LGD or HGD.

Results: Of the 287 patients with LGD, 21 (7%) developed more-advanced lesions (HGD or CAC) after a median time period of 86 months (interquartile range, 34-214). Of the 28 patients with HGD, 4 (14%) developed CAC after a median time period of 180 months (interquartile range, 23-444). The overall cumulative incidence of CAC at 10 years after an initial diagnosis of HGD was 24.3% and after an initial diagnosis of LGD was 8.5% (P < .05). Metachronous lesions, non-polypoid lesions, and colonic stricture were associated with risk of occurrence of more-advanced lesions after LGD (P < .05). Of the 630 dysplastic lesions identified during endoscopy, 545 (86%) were removed during the same procedure or during a follow-up endoscopy or by surgery. Of 111 patients with CAC, 95 (86%) did not have prior detection of dysplasia and 64 of these 95 patients (67%) developed CAC outside of the screening or surveillance period recommended by the European Crohn's and Colitis Organisation.

Conclusions: In an analysis of pathology data from 7 medical centers in Belgium, we found a low rate of detection of more-advanced lesions following detection of LGD or HGD-taking into account that most of the lesions were removed. Main risk factors for development of more-advanced lesions after LGD were metachronous lesions, non-polypoid lesions, and colon strictures.

Keywords: CRC; Colorectal Cancer; Crohn’s Disease; Endoscopy Resection; Ulcerative Colitis.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Colonoscopy
Colorectal Neoplasms*
Crohn Disease*
Humans
Hyperplasia
Inflammatory Bowel Diseases* / complications
Retrospective Studies