Dysplastic Lesions In Ulcerative Colitis Research Articles

Long-Term Outcomes after Endoscopic Submucosal Dissection for Ulcerative Colitis-Associated Dysplasia

Introduction: The Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations guidelines recommend surveillance colonoscopy instead of colectomy after the complete removal of “endoscopically resectable” dysplastic lesions in ulcerative colitis (UC). There are no studies on long-term outcomes of endoscopic submucosal dissection (ESD) for UC-associated neoplasia (UCAN). We aimed to evaluate the clinical outcomes of ESD for UC-associated dysplasia (UCAD) during long-term follow-up. Methods: We retrospectively enrolled 17 consecutive UC patients with 22 UCADs, who underwent initial ESD or total proctocolectomy at the Hiroshima University Hospital. The clinicopathological features of the patients and neoplasias and clinical outcomes of ESD were evaluated and compared with those of total proctocolectomy. Results: UCAD in the ESD and total proctocolectomy groups was mostly noted on the left side of the colon, and most lesions were superficial macroscopic lesions. In the ESD group, en bloc resection and histological complete resection rates were 83 and 67%, respectively. One patient died of malignant melanoma; however, none of the patients died of UC-associated carcinoma in both groups. Metachronous neoplasias developed in 5 of the 7 patients in the ESD group. Among the 5 patients with metachronous UCAN, 4 finally underwent total proctocolectomy and 1 underwent additional ESD. Conclusions: ESD for UCAD is a useful method for total excisional biopsy. UC patients with UCAD resected by ESD have a high risk of developing metachronous UCAN during the follow-up period.

781 – Quantifying Evolution of Early Dysplastic Lesions in Ulcerative Colitis Predicts Future Colorectal Cancer Risk

781 – Quantifying Evolution of Early Dysplastic Lesions in Ulcerative Colitis Predicts Future Colorectal Cancer Risk

Low prevalence of dysplastic polyps in patients with ulcerative colitis

Patients with ulcerative colitis (UC) are prone to colorectal cancer and dysplastic polyps and also have sporadic adenomas. There is scant information, however, relating the prevalence of sporadic adenomas in UC patients compared with normal subjects. The aim of this study was to assess the prevalence of all dysplastic lesions in UC and compare the prevalence of adenomas to that in the general population. A single-center retrospective study, in which all patients with diagnosed UC were followed during a ten-year period. The incidence of polyps and colorectal cancers were recorded and compared to that of an age-matched group in the general population who had screening colonoscopy. A total of 229 UC patients were included compared with 450 age-matched subjects who underwent a single colonoscopy. The average number of colonoscopies per UC patient was 3. The rate of sporadic adenomas among UC patients (9.6%), as well as the rate of all dysplastic polyps (11.2%) in these patients, were significantly lower than the rate of adenomas among the control population (24%; OR 0.33-0.44; P<0.0001). Despite this, the rates of colon cancer were comparable between the groups (2.1% vs. 1.5%, P=0.55). In spite of the observed lower rate of dysplastic polyps in UC patients, this should not preclude tight surveillance in this high-risk population.

Sa1551 Endoscopic Submucosal Dissection for Dysplastic Lesions in Ulcerative Colitis

Sa1551 Endoscopic Submucosal Dissection for Dysplastic Lesions in Ulcerative Colitis

Tu1529 Endoscopic Resection of Raised Dysplastic Lesions in Ulcerative Colitis: Long-Term Outcome

Tu1529 Endoscopic Resection of Raised Dysplastic Lesions in Ulcerative Colitis: Long-Term Outcome

The diagnostic accuracy of chromoendoscopy for dysplasia in ulcerative colitis: meta‐analysis of six randomized controlled trials

The diagnostic accuracy of chromoendoscopy for dysplasia in ulcerative colitis (UC) was systematically evaluated. Original studies in any language were searched from PubMed and Embase. Meta-analysis of prospective studies that compared chromoendoscopy with histological diagnosis was carried out. Sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each study and pooled together; summary receiver operating characteristic (ROC) and subgroup analyses were performed, while the quality of the study and heterogeneity were assessed. Six randomized controlled trials were included, which used methylene blue or indigo carmine dye spray. The meta-analysis demonstrated a pooled sensitivity of 83.3% (95% confidence interval (CI), 35.9-99.6%), specificity of 91.3% (95% CI, 43.8-100%), and DOR of 17.544 (95% CI, 1.245-247.14). Subgroup analyses revealed that both the methylene blue dye spray subgroup and the unspecified endoscopist subgroup include the same studies, and their pooled sensitivity and specificity were 0.737 and 0.917, respectively. The other subgroup, which used indigo carmine dye spray, had overall higher sensitivity (0.930) and lower specificity (0.910). Chromoendoscopy has medium to high sensitivity and a high diagnostic accuracy for dysplastic lesions in UC.

Comparison of ulcerative colitis surveillance strategies. an analysis of cost-effectiveness

IntroductionThe latest (2010) British Society of Gastroenterology (BSG) guidelines on colonoscopic surveillance in colitis (1) propose surveillance intervals based on risk of dysplasia determined by endoscopic and histological findings using...

Dysplastic lesions in ulcerative colitis: Changing paradigms

Crohn and Rosenberg first highlighted the increased risk of colorectal cancer in ulcerative colitis in 1925. Cancer rates as high as 34 percent after 30 yrs of disease have been reported in several population-based studies, although the reported risk varies substantially. Lower rates have been reported in: population-versus specialist centre-cohorts, local practices with a high colectomy rate and high 5-aminosalicylate usage, and more recent as opposed to older reports. Despite this variation in reported risk, and lack of controlled evidence for cancer reduction, colonoscopic surveillance programmes are a routine part of care in many centres. Cancer is believed to arise most commonly in dysplastic epithelium, and the detection of either dysplasia or early cancer forms the basis of such programmes. Further confusion stems from the variety of terms used to describe dysplastic change.

Non-Polypoid Colorectal Neoplasms in Ulcerative Colitis

The incidence of colorectal cancer associated with ulcerative colitis (UC) increases with time. It is imperative to identify dysplasia-associated lesions or masses (DALM) and non-polypoid colorectal neoplasms (NP-CRN) to reduce the morbidity and mortality from colorectal cancer associated with UC. Recent findings suggest most dysplastic lesions in UC can be considered as visible under careful endoscopic observation. To find NP-CRN in UC, the careful examination of well-prepared mucosa and noting subtle differences is necessary. Magnifying chromoendoscopy, therefore, can be useful to endoscopically diagnose these subtle findings. The authors believe that targeted biopsies during chromoendoscopy will increasingly be used and replace random biopsies in the future.

Autofluorescence imaging colonoscopy for the detection of dysplastic lesions in ulcerative colitis: a pilot study

Autofluorescence imaging (AFI) is a novel technology for endoscopy, which enhances neoplastic lesions of the gastrointestinal tract. The aim of this investigation was to examine whether AFI colonoscopy can identify dysplasia in ulcerative colitis. We examined 48 patients with ulcerative colitis by AFI colonoscopy. Apparently flat, coarse granular mucosa and visible protruding lesions under conventional colonoscopy were observed by AFI. Those target areas were classified into low AF and high AF according to the colour under AFI colonoscopy. The grade of dysplasia was determined in the specimens obtained from the target areas. About 126 sites (35 protruding lesions and 91 flat areas) were examined by AFI colonoscopy. AF was determined to be high in 42 areas and to be low in 84 areas. The positive rate of dysplasia was higher in protrusions (31%) than in flat mucosa (3.3%, P < 0.0001). The rate of positive dysplasia was not statistically different between lesions determined to be low AF (14%) and those to be high AF (5%, P = 0.09). The positive rate of dysplasia in protruding lesions was significantly higher in low AF than in high AF (45.0%vs 13.3%, P = 0.043), while the value in flat lesions was not different between low AF and high AF (8.2%vs 0%, P = 0.3). Autofluorescence imaging colonoscopy seems to have a role for the detection of dysplaia in ulcerative colitis.

Author reply to ‘Letter to the Editor: Are adenomatous polyps rare in ulcerative colitis?’

Sirs, We appreciate the interest shown by Dr Rutter1 in our paper.2 He re-emphasizes the difficulties in classifying dysplastic lesions in patients with ulcerative colitis. He makes a valid point that if flat dysplasia in colitic mucosa is included, then the number of patients with dysplastic lesions (flat dysplasia, DALMs or adenoma-like DALMs) in our ulcerative colitis population did not differ from the number of patients with dysplastic lesions (adenomatous polyps) in our control population. However, we deliberately set out to focus on polypoid lesions, i.e. elevations of discrete tissue mass protruding into the colonic lumen. In this respect, dysplastic polyps were statistically less likely to be found in our ulcerative colitis patients than in controls. Our finding of reduced dysplastic polyp formation in ulcerative colitis and Dr Rutter's argument that there is altered morphology of dysplastic lesions in ulcerative colitis are not mutually exclusive. Dr Rutter also highlights the difficulties in differentiating DALMs and adenoma-like DALMs in ulcerative colitis. It is interesting that his study3 published soon after our report, also similarly concluded that in the absence of associated flat dysplasia, it is the endoscopic resectability of a dysplastic polypoid lesion that leads it to being classified as adenoma-like DALM (endoscopically completely resectable, no increased cancer risk above that of other chronic colitic patients) or a DALM (not endoscopically resectable, very high cancer risk).

Most dysplasia in ulcerative colitis is visible at colonoscopy

Background Patients with long-standing extensive ulcerative colitis are at increased risk for colorectal carcinoma. Because most dysplasia is believed to be macroscopically invisible, recommended surveillance protocols include multiple non-targeted colonic biopsies. It was hypothesized by us that most dysplasia is actually colonoscopically visible. This study assessed the proportion of dysplasia that has been detected macroscopically in patients who underwent colonoscopy surveillance at our center. Methods A retrospective review was conducted of colonoscopically detected neoplasia (dysplasia or cancer) in patients with ulcerative colitis who underwent surveillance from 1988 through 2002. An established surveillance protocol was used in all cases that included random segmental biopsies every 10 cm throughout the length of the colon, in addition to targeted biopsies of macroscopic lesions. Neoplasia detection was categorized as resulting from either targeted or non-targeted (“random”) biopsies. Follow-up information was obtained to the study end. Results A total of 525 patients underwent 2204 surveillance colonoscopies. A total of 110 neoplastic areas were detected in 56 patients: 85 (77.3%) were macroscopically visible at colonoscopy, and 25 (22.7%) were macroscopically invisible. Fifty patients (89.3%) had macroscopically detectable neoplasia, and 6 (10.7%) had macroscopically invisible lesions. The frequency of cancer in patients who had endoscopic resection of neoplasia did not differ from that for the surveillance population as a whole (1/40 vs. 18/525; p = 1.0, Fisher exact test), irrespective of whether the lesion was thought to be an adenoma or a dysplasia-associated lesion/mass. Conversely, a high proportion of unresectable lesions harbored cancer. Conclusions Most dysplastic lesions in ulcerative colitis are visible at colonoscopy. From a clinical perspective, the endoscopic resectability of a lesion is more important than whether it is thought to be a sporadic adenoma or a dysplasia-associated lesion/mass.

Long-term follow-up after polypectomy treatment for adenoma-like dysplastic lesions in ulcerative colitis

Background & Aims: A previously published study by our group suggested that adenoma-like dysplasia-associated lesions or masses (DALMs) in ulcerative colitis (UC) may be treated adequately by polypectomy and continued endoscopic surveillance. The length of follow-up evaluation in these patients averaged only 42 months. The purpose of this study was to evaluate the long-term outcome of our previously defined group of UC patients, all with adenoma-like DALMs, who were treated by polypectomy. Methods: The clinical, endoscopic, and pathologic outcome of 34 UC patients, 24 with an adenoma-like DALM, and 10 with a coincidental sporadic adenoma, 28 of whom were treated by polypectomy and continued endoscopic surveillance, and 6 by colonic resection, were compared with the outcome of 49 non-UC patients who were treated similarly for a sporadic adenoma. The mean length of follow-up evaluation averaged 82.1 months and 71.8 months for the 2 UC subgroups, respectively, and 60.4 months for the non-UC controls. Results: Overall, 20 of 34 UC patients (58.8%) developed at least one further adenoma-like DALM on follow-up evaluation. One patient had flat low-grade dysplasia present in the colon, which was resected within 6 months of the initial polypectomy, and another patient, with primary sclerosing cholangitis, developed adenocarcinoma 7.5 years after her initial polypectomy. There was no significant difference in the prevalence of polyp formation on follow-up evaluation between UC patients with an adenoma-like DALM (62.5%) and UC patients with a sporadic adenoma (50%), or between either of these 2 UC patient subgroups and the non-UC sporadic adenoma patient group (49%; P > 0.05). Conclusions: UC patients who develop an adenoma-like DALM may be treated adequately by polypectomy with complete excision and continued endoscopic surveillance.

Sialosyl‐Tn expression in benign and neoplastic proliferative lesions of the colon: of questionable value in predicting dysplasia

Tumour-associated carbohydrate antigen expression patterns have been observed to change during the transformation from benign to dysplastic and malignant cells. Sialosyl-Tn is an O-linked mucin-type tumour-associated antigen expressed on glycoproteins and is the product of aberrant glycosylation of the Tn glycoprotein, an early precursor of the MN blood group antigen. Sialosyl-Tn expression has been observed in adenomas and carcinomas of the colon as well as in dysplastic lesions in ulcerative colitis (UC). Sialosyl-Tn expression has been proposed to be a prognostic marker for the development of dysplasia in UC. To evaluate Sialosyl-Tn expression in benign and malignant proliferative lesions of the colon, and its relevance for prediction of dysplasia, we immunostained cases of adenoma, adenoma with invasive carcinoma, UC with and without dysplasia, hyperplastic polyps, cases of lymphocytic colitis, and cases of acute self-limited colitis with antibody against Sialosyl-Tn. We found expression of Sialosyl-Tn in dysplastic lesions in adenomas and UC. We also found expression of Sialosyl-Tn in epithelium of chronic colitis in virtually all patients with UC, both with dysplasia and without. Sialosyl-Tn was also present in hyperplastic polyps, and one single case each of lymphocytic colitis and acute self-limited colitis. We conclude that Sialosyl-Tn is expressed in dysplastic and malignant epithelial lesions of the colon. Expression of Sialosyl-Tn in benign proliferative/regenerative lesions in the colon is frequent and is not directly related to the development of dysplasia. Possible mechanisms of Sialosyl-Tn expression are discussed.