305 Clinical Significance of Pseudopolyps for Patients With Inflammatory Bowel Disease

Abstract

INTRODUCTION: Postinflammatory polyps (PIPs), often referred to as “pseudopolyps,” have previously been associated with an increased risk for colorectal neoplasia (CRN) in inflammatory bowel disease (IBD) patients. This has resulted in some IBD patients with PIPs receiving a more aggressive colorectal cancer (CRC) surveillance strategy. However, newer studies have questioned whether the presence of PIPs increases overall risk for CRN. Recently, a multi-centered retrospective study did not find any association between the presence of PIPs in patients with IBD undergoing CRC surveillance and the development of CRN. We also suspected that PIPs did not confer any increased risk of CRN and speculated that this may in fact be explained by the degree of inflammation in the associated colonic segments. Our study sought to better understand the relationship between the presence of PIPs, colonic inflammation and subsequent risk for development of CRN. METHODS: We performed a retrospective analysis of patients entered from 1/1/1996 to 9/1/2018 in the MICISTA IBD registry at Saint Antoine Hospital in France. Patients were included if they had PIPs on at least one colonoscopy. Those with a questionable IBD diagnosis or without a colon were excluded. Endoscopy reports were divided into 4 segments for analysis. Each segment was then graded according to the number of PIPs identified per segment and the degree of endoscopic inflammation. The corresponding pathology reports were then also reviewed by segment for histological IBD activity using the Nancy histological index. Patients were also compared to a historical cohort of IBD patients without PIPs. Logistical regression was used to identify factors associated with detection of neoplasia in segments with and without PIPs. RESULTS: 471 IBD patients were identified with a total of 607 endoscopies containing PIPs. 40 patients were found to have CRN. Preliminary analysis did not show any clear association between the presence of PIPs and the subsequent development of colorectal neoplasia. CONCLUSION: PIPs continue to pose a clinical dilemma for risk stratifying patients with IBD. Newer studies appear to upend the old knowledge that PIPs mandate a more aggressive approach to CRC surveillance. We suspect, with carefully performed endoscopy, these IBD patients may not require colonoscopies any more frequently than those without PIPs. This less intensive management strategy may lead to significant health cost-savings as well as improved quality of life for patients.