S71 Role of High-Resolution Anoscopy in Inflammatory Bowel Disease

Abstract

Background: Anal squamous cell carcinoma is rare, but its incidence and mortality have been increasing worldwide, and 90% of cases are related to HPV infection. Patients with Inflamatory Bowel disease (IBD), have a higher risk than the general population, It has been identified: 5.5 per 100,000 patients in the IBD group vs 1.8 in the non-IBD group. This is due to the prolonged inflammatory state, which decreases viral clearance of HPV; and the persistence of HPV in the transition zone in the anal canal, increases the possibility of developing premalignant lesions and consequently anal cancer. Likewise, prolonged management with anti-TNF and steroids, generates loss of cell cycle regulation, altering viral clearance. Should we add a new risk population group to the literature? Currently, there are no recommendations for anal canal HPV screening in patients with IBD, so we conducted a study with the purpose of confirming the presence of HPV-related premalignant lesions in the anal canal that could explain the high risk of anal cancer development in these patients, and to develop a screening algorithm in which high-resolution anoscopy is the cornerstone for the diagnosis and treatment of premalignant lesions Methods: A prospective cohort study was conducted in which we included patients under follow-up for IBD, without perianal symptoms, between January 2022 and July 2022 at the Instituto de Coloproctology in Medellín, who underwent anal cytology, genotyping of hHPV and high-resolution anoscopy, after explanation and acceptance of the procedure. If lesions were found, ablative treatment was performed. Results: A total of 21 patients with IBD were included. Six percent presented failure of the first line of management and were under anti-TNF management; 23% had low-grade squamous lesions, while 14.2% had high-grade lesions with changes of dysplasia at the time of anoscopy; 90.4% had positive genotyping for HPV of which 76.1% were high-grade; 76.1% patients had dysplasia which was 87% associated with high-risk HPV. Conclusion(s): Our study demonstrates that IBD patients behave as a high risk group for developing premalignant lesions in association with HPV, such as, high grade lesion which was found in 14.2% of patients and dysplasia in 76%. The persistent inflammatory state, the use of steroids and anti-TNF play an important role in decreasing the viral clearance of HPV, so a more exhaustive study should be performed in patients with IBD; to establish the frequency of lesions and the viral genetic profile that could be related to the development of anal cancer. High resolution anoscopy is a cost effective, painless and affordable method that in expert hands can efficiently diagnose and treat premalignant lesions and decrease the incidence of anal cancer in patients with IBD.