Surveillance For Dysplasia In Patients Research Articles

Association of Crohn’s Disease and Hepatic Cirrhosis Post-Primary Sclerosing Cholangitis: A Case Report

Primary sclerosing cholangitis (PSC) is a distinct entity associated with inflammatory bowel disease (IBD). We report the case of a 49-year-old patient with ileocecal Crohn’s disease of the stenosing phenotype, presenting with perianal lesions in the form of fistulas, who was diagnosed with PSC complicated by hepatic cirrhosis following the development of clinical and biological cholestasis, as well as his first ascitic decompensation. After initiating treatment with azathioprine for Crohn's, he experienced significant abdominal pain, ascites, and jaundice, leading to further investigations. MRI revealed bile duct stenosis, and endoscopic procedures confirmed portal hypertension. After excluding secondary causes, a diagnosis of PSC was made. Treatment with methotrexate and ursodeoxycholic acid resulted in clinical improvement. The discussion emphasizes the rare but notable association between Crohn's disease and PSC, outlining diagnostic challenges and management strategies. It highlights the poor prognosis linked to PSC, including risks of cirrhosis and colorectal cancer, with recommendations for regular monitoring and surveillance for dysplasia in patients with both conditions. Overall, the study underscores the need for careful management and ongoing research into effective treatments for this challenging dual diagnosis.

Endoscopic approaches to the management of dysplasia in inflammatory bowel disease: A state-of-the-art narrative review.

Patients with inflammatory bowel disease (IBD) are at an increased risk of developing colitis-associated neoplasia (CAN), including colorectal cancer (CRC), through the inflammation-dysplasia-neoplasia pathway. Dysplasia is the most reliable, early and actionable marker for CAN in these patients. While such lesions are frequently encountered, adequate management depends on an accurate assessment, complete resection and close surveillance. With recent advances in endoscopic technologies and research in the field of CAN, the management of dysplastic lesions has significantly improved. The American Gastroenterology Association and Surveillance for Colorectal Endoscopic Neoplasia Detection (SCENIC) provide a guideline framework for approaching dysplastic lesions in patients with IBD. However, there are significant gaps in these recommendations and real-world clinical practice. Accurate lesion assessment remains pivotal for adequate management of CAN. Artificial intelligence-guided modalities are now increasingly being used to aid the detection of these lesions further. As the lesion detection technologies are improving, our armamentarium of resection techniques is also expanding and includes hot or cold polypectomy, endoscopic mucosal resection, endoscopic sub-mucosal dissection and full-thickness resection. With the broadened scope of endoscopic resection, the recommendations regarding surveillance after resection has also changed. Certain patient populations such as those with invisible dysplasia or with prior colectomy and ileal pouch anal anastomosis need special consideration. In the present review, we aim to provide a state-of-the-art summary of the current practice of endoscopic detection, resection and surveillance of dysplasia in patients with IBD and provide some perspective on the future directions based on the latest research.

Clinicopathologic features of undetected dysplasia found in total colectomy or proctocolectomy specimens of patients with inflammatory bowel disease.

It remains controversial as to whether targeted biopsies should completely replace random biopsies for dysplasia surveillance in patients with inflammatory bowel disease (IBD). Several histologic patterns of nonconventional dysplasia have been described in IBD. This study aimed to investigate the rate and clinicopathologic features of dysplastic lesions found in total colectomy or proctocolectomy specimens that were undetected on prior colonoscopy. The study analyzed 207 consecutive IBD patients who underwent a total colectomy or proctocolectomy and had at least one high-definition colonoscopy prior to colectomy. Dysplasia found in the colectomy specimens was classified as undetected, only when there was no corresponding site of dysplasia detected on previous colonoscopic biopsies. Twenty-seven (13%) patients had 49 undetected dysplastic lesions found only at colectomy, while 22 (11%) had 31 previously detected dysplastic lesions only. The remaining 158 (76%) patients had no dysplasia. A greater proportion of the undetected (19%) or previously detected (23%) dysplasia group had concurrent primary sclerosing cholangitis compared with only 3% in the group without dysplasia (P < 0.001). The undetected dysplastic lesions were more likely to have nonconventional dysplastic features (76%), low-grade dysplasia (94%), and a flat/invisible gross appearance (73%) compared with the previously detected dysplastic lesions (13%, 68%, and 48%, respectively) (P < 0.05). Almost all patients with undetected dysplasia (93%) had a colonoscopy within 1 year of colectomy. The rate of undetected dysplasia is not insignificant (13%), suggesting that increased random biopsies may improve the rate of dysplasia detection, including nonconventional dysplasia.

S0677 An Indian National Survey of Gastroenterologists' Views on Dysplasia Surveillance and Chromoendoscopy in IBD

INTRODUCTION: International societal guidelines support use of chromoendoscopy (CE) for dysplasia surveillance in patients with inflammatory bowel disease (IBD). Our objective was to assess current dysplasia surveillance practices among gastroenterologists in India, which has the second highest number of patients with IBD after the USA. METHODS: A 31-question survey was distributed to members of the Indian Society of Gastroenterology. RESULTS: A total of 128 participated (94.5% male) with 87.5% consultant gastroenterologists (GI), 6.25% clinicians with GI interest & 6.25% GI trainees. Of these, 117 (91.4%) participants agreed that IBD patients in India require colonoscopic surveillance, 100 (78.2%) carried out surveillance colonoscopies. The 3 most common reasons for not performing IBD surveillance were lack of local guidelines (78.6%), cost constraints (78.6%) and perceived low-risk of colorectal cancer from IBD in Indians compared to the West (75%). Information on the practice of surveillance colonoscopy was available for 89/100 (89%). The preferred surveillance modality was standard white light endoscopy (WLE) by 38.2%, high definition WLE by 24.7%, narrow band imaging by 27% & dye-based (DB) chromo-endoscopy (CE) by 10.1%. 41.6% did not feel confident using CE, 44.9% felt confident using dye-less CE and 16.8% were confident of using DB CE. Random biopsies were considered an effective method of detecting neoplasia by 41 (46.1%) 65 (73%) were aware of recommendations from major organisations endorsing use of CE over random biopsies. The average number of biopsies performed at surveillance was 13 (median 10, IQR 10.25) with 16.7% performing quadrantic biopsies at 10 cm intervals in >50% of patients. The biggest barrier considered for using newer endoscopic modalities was financial constraints (77.1%) and 69.9% felt patients would receive better care with availability of novel endoscopic tools. The need for local IBD dysplasia surveillance guidelines was suggested by 79.8%. CONCLUSION: We noted a high level of awareness regarding dysplasia surveillance but considerable variation in practice amongst GI clinicians in India. Cost constraints and lack of local guidelines were deemed significant barriers for modern dysplasia surveillance. The rising incidence and prevalence of IBD in India emphasises an urgent need for training and pragmatic guidelines to improve surveillance strategies.

Surveillance in inflammatory bowel disease: is chromoendoscopy the only way to go? A systematic review and meta-analysis of randomized clinical trials.

Background and study aims Ulcerative colitis (UC) and Crohn’s disease (CD) have higher risk of colorectal cancer (CRC). Guidelines recommend dysplasia surveillance with dye-spraying chromoendoscopy (DCE). The aim of this systematic review and meta-analysis was to review all randomized clinical trials (RCTs) available and compare the efficacy of different endoscopic methods of surveillance for dysplasia in patients with UC and CD. Methods Databases searched were Medline, EMBASE, Cochrane and SCIELO/LILACS. It was estimated the risk difference (RD) for dichotomous outcomes (number of patients diagnosed with one or more dysplastic lesions, total number of dysplastic lesions diagnosed and number of dysplastic lesions detected by targeted biopsies) and mean difference for continuous outcomes (procedure time). Results This study included 17 RCTs totaling 2,457 patients. There was superiority of DCE when compared to standard-definiton white light endoscopy (SD-WLE). When compared with high-definition (HD) WLE, no difference was observed in all outcomes (number of patients with dysplasia (RD 0.06; 95 % CI [–0.01, 0.13])). Comparing other techniques, no difference was observed between DCE and virtual chromoendoscopy (VCE – including narrow-band imaging [NBI], i-SCAN and flexible spectral imaging color enhancement), in all outcomes except procedure time (mean difference, 6.33 min; 95 % CI, 1.29, 11.33). DCE required a significantly longer procedure time compared with WLE (mean difference, 7.81 min; 95 % CI, 2.76, 12.86). Conclusions We found that dye-spraying chromoendoscopy detected more patients and dysplastic lesions than SD-WLE. Although no difference was observed between DCE and HD-WLE or narrow-band imaging, the main outcomes favored numerically dye-spraying chromoendoscopy, except procedure time. Regarding i-SCAN, FICE and auto-fluorescence imaging, there is still not enough evidence to support or not their recommendation.

Endocuff Vision is safe to use for dysplasia surveillance in patients with ulcerative colitis: a feasibility study.

Background and study aims Endocuff Vision improves adenoma detection rates in patients without inflammatory bowel disease. This study aimed to investigate the safety and feasibility of Endocuff Vision-assisted high-definition white light endoscopy (HDWLE) with dye-spray chromoendoscopy for detection of dysplasia in patients with ulcerative colitis. Patients and methods Patients with clinically inactive ulcerative colitis due for dysplasia surveillance were recruited. Procedural endpoints included safety, cecal intubation rate (CIR), terminal ileum intubation rate (TIR), withdrawal time, polyp detection rate, dysplasia detection rate (DDR), and sessile serrated lesion detection rate. Results Twenty-five patients (9 female, median age 57 [range 28 – 82] years) were studied. Endocuff Vision-assisted HDWLE was completed in all participants, with a CIR of 100 %, in a median 4 minutes (range 2 – 16), and a TIR of 88% in a median of 6.5 minutes (range 3 – 19). Median withdrawal time was 18 minutes (range 10 – 55), including application of dye-spray, biopsies and polypectomy. The Mayo Endoscopic subscore was 0 in 11, 1 in 9, and 2 in 5 patients. The DDR was 24 % (6 patients had a total of 12 dysplastic lesions) and sessile serrated lesion detection rate was 12 % (3 patients had a total of 4 sessile serrated polyps). No serious adverse events occurred, with one patient developing clinically insignificant minor mucosal bleeding. Conclusion Endocuff Vision-assisted HDWLE is feasible and safe in patients with ulcerative colitis undergoing dysplasia surveillance. Further studies are required to assess superiority of this technique compared with standard high-definition white light endoscopy with chromoendoscopy.

Surveillance for dysplasia in patients with ulcerative colitis: Discrepancy between guidelines and practice

Background and aim The risk of developing colorectal cancer is higher in patients with ulcerative colitis (UC) than in the general population. Guidelines recommend surveillance colonoscopy (SCS) to reduce mortality; however, few studies have assessed physicians’ adherence to guidelines. This study was aimed to clarify the current status of SCS and adherence to guidelines through the characteristics of cancer/dysplasia surveillance for UC patients in Japan. Methods A questionnaire was mailed to 541 physicians who attended meetings on inflammatory bowel disease. Results The respondents encountered a median of 100 UC cases. Thirty percent of the respondents had never managed a UC patient with cancer. Fifty-one percent of the respondents had never diagnosed colorectal cancer with UC. Forty-seven percent of the respondents considered total colitis and left-sided colitis as indications for SCS, and 38% performed SCS regardless of the disease extent. Sixty-three percent of the respondents started SCS at 7–10 years after UC onset, whereas 20% started SCS at 3 years or less. Fifty-two percent of the respondents obtained targeted biopsies only, and chromoendoscopy was employed by 49% of the respondents as a special technique for surveillance. The median number of biopsies at SCS was 5 per patient; it was 3 among patients performed by physicians who obtained targeted biopsies only and 7 among those performed by physicians who obtained step biopsies and targeted biopsies (p < 0.0001). Conclusion A considerable proportion of the respondents did not follow the guidelines when selecting patients for surveillance and performing SCS. This article is protected by copyright. All rights reserved.

Chromoendoscopy versus autofluorescence imaging for neoplasia detection in patients with longstanding ulcerative colitis (FIND-UC): an international, multicentre, randomised controlled trial

Patients with longstanding ulcerative colitis undergo regular dysplasia surveillance because they have an increased colorectal cancer risk. Autofluorescence imaging and chromoendoscopy improve dysplasia detection. The aim of this study was to determine whether autofluorescence imaging should be further studied as an alternative method for dysplasia surveillance in patients with longstanding ulcerative colitis. This prospective, international, randomised controlled trial included patients from an ulcerative colitis-dysplasia surveillance cohort from five centres in the Netherlands and the UK. Eligible patients were aged 18 years or older who were undergoing dysplasia surveillance after being diagnosed with extensive colitis (Montreal E3) at least 8 years before study start or with left-sided colitis (Montreal E2) at least 15 years before study start. Randomisation (1:1) was minimised for a previous personal history of histologically proven dysplasia and concomitant primary sclerosing cholangitis. The coprimary outcomes were the proportion of patients in whom at least one dysplastic lesion was detected and the mean number of dysplastic lesions per patient. The relative dysplasia detection rate, calculated as the ratio of the detection rates by autofluorescence imaging and chromoendoscopy, needed to be more than 0·67 (using an 80% CI) for both primary outcomes to support a subsequent large non-inferiority trial. Outcomes were analysed on a per-protocol basis. The trial is registered at the Netherlands Trial Register, number NTR4062. Between Aug 1, 2013, and March 10, 2017, 210 patients undergoing colonoscopy surveillance for longstanding ulcerative colitis were randomised for inspection with either autofluorescence imaging (n=105) or chromoendoscopy (n=105). Dysplasia was detected in 13 (12%) patients by autofluorescence imaging and in 20 patients (19%) by chromoendoscopy. The relative dysplasia detection rate of autofluorescence imaging versus chromoendoscopy for the proportion of patients with ulcerative colitis with at least one dysplastic lesion was 0·65 (80% CI 0·43-0·99). The mean number of detected dysplastic lesions per patient was 0·13 (SD 0·37) for autofluorescence imaging and 0·37 (1·02) for chromoendoscopy (relative dysplasia detection rate 0·36, 80% CI 0·21-0·61). Adverse events were reported for two patients in the autofluorescence imaging group (one patient had intraprocedural mild bleeding, and one patient had abdominal pain) and for three patients in the chromoendoscopy group (two patients had intraprocedural mild bleeding, and one patient had perforation). Autofluorescence imaging did not meet criteria for proceeding to a large non-inferiority trial. Therefore, existing autofluorescence imaging technology should not be further investigated as an alternative dysplasia surveillance method. Olympus Europe and Olympus Keymed.

Perspectives on endoscopic surveillance of dysplasia in inflammatory bowel disease: a survey of academic gastroenterologists.

Background and study aims Dye-based chromoendoscopy (DBC) is the preferred method for endoscopic dysplasia surveillance in patients with inflammatory bowel disease (IBD). We sought to examine the uptake of, and perception toward DBC among academic gastroenterologists. Methods We conducted an online survey of academic members of the Canadian Association of Gastroenterology to assess their current dysplasia surveillance practice, uptake of DBC, and perceived barriers to adoption of DBC. Results Of the 150 physicians contacted, 49 (32.7 %) responded to the survey. The majority of respondents reported subspecialty training in IBD (71.4 %), and the median number of years in practice was 12. White-light endoscopy with random colonic biopsies was the preferred dysplasia screening method (73.5 %). Only 26.5 % of respondents routinely used DBC, despite institutional availability of over 60 %. The major barriers to adoption of DBC were concerns about procedure duration (46.9 %), concerns about cost (44.9 %), and inadequate training (40.8 %). Conclusion There is low uptake of DBC for dysplasia surveillance in IBD patients among academic gastroenterologists practicing in Canada. Additional studies should be completed to determine how to improve the uptake of DBC.

Surveillance for dysplasia in patients with ulcerative colitis: Discrepancy between guidelines and practice.

The risk of developing colorectal cancer is higher in patients with ulcerative colitis (UC) than in the general population. Guidelines recommend surveillance colonoscopy (SCS) to reduce mortality; however, few studies have assessed physicians' adherence to guidelines. This study was aimed to clarify the current status of SCS and adherence to guidelines through the characteristics of cancer/dysplasia surveillance for UC patients in Japan. A questionnaire was mailed to 541 physicians who attended meetings on inflammatory bowel disease. The respondents encountered a median of 100 UC cases. Thirty percent of the respondents had never managed a UC patient with cancer. Fifty-one percent of the respondents had never diagnosed colorectal cancer with UC. Forty-seven percent of the respondents considered extensive colitis and left-sided colitis as indications for SCS, and 38% carried out SCS regardless of the disease extent. Sixty-three percent of the respondents started SCS at 7-10 years after UC onset, whereas 20% started SCS at 3 years or less. Fifty-two percent of the respondents obtained targeted biopsies only, and chromoendoscopy was used by 49% of the respondents as a special technique for surveillance. Median number of biopsies at SCS was five per patient; it was three among patients whose biopsy was carried out by physicians who obtained targeted biopsies only and seven among those carried out by physicians who obtained step biopsies and targeted biopsies (P < 0.0001). A considerable proportion of the respondents did not follow the guidelines when selecting patients for surveillance and carrying out SCS.

Advanced gastrointestinal endoscopic imaging for inflammatory bowel diseases.

Gastrointestinal luminal endoscopy is of paramount importance for diagnosis, monitoring and dysplasia surveillance in patients with both, Crohn's disease and ulcerative colitis. Moreover, with the recent recognition that mucosal healing is directly linked to the clinical outcome of patients with inflammatory bowel disorders, a growing demand exists for the precise, timely and detailed endoscopic assessment of superficial mucosal layer. Further, the novel field of molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapeutic responses. Within this review, we describe how novel endoscopic approaches and advanced endoscopic imaging methods such as high definition and high magnification endoscopy, dye-based and dye-less chromoendoscopy, confocal laser endomicroscopy, endocytoscopy and molecular imaging now allow for the precise and ultrastructural assessment of mucosal inflammation and describe the potential of these techniques for dysplasia detection.

P172 Photodynamic surveillance of colitis-associated dysplasia in patients with ulcerative colitis and in mouse model, by visualization following oral 5-aminolevulinic acid sensitization

P172 Photodynamic surveillance of colitis-associated dysplasia in patients with ulcerative colitis and in mouse model, by visualization following oral 5-aminolevulinic acid sensitization

Novel diagnostic and therapeutic techniques for surveillance of dysplasia in patients with inflammatory bowel disease.

The risk for developing dysplasia and colorectal cancer in patients with longstanding inflammatory bowel disease (IBD) involving the colon is well documented. Random biopsies during white-light, standard-definition colonoscopy (33 to 50 biopsies) with or without dye spraying chromoendoscopy has been the recommended strategy in North America to detect dysplastic lesions in IBD. However, there are several limitations to this approach including poor physician adherence, poor sensitivity, increased procedure time and considerable cost. The new generation of high-definition endoscopes with electronic filter technology provide an opportunity to visualize colonic mucosal and vascular patterns in minute detail, and to identify subtle flat, multifocal, polypoid and pseudopolypoid neoplastic and non-neoplastic lesions. The application of these new technologies in IBD is slowly being adopted in clinical practice. In addition, the advent of confocal laser endomicroscopy provides an opportunity to explore real-time histology, thus redefining the understanding and characterization of the lesions in IBD. There is emerging evidence that serrated adenomas are also associated with longstanding IBD colitis and may be recognized as another important contributing factor to colorectal cancer development. The circumscribed neoplastic lesions can be treated using endoscopic therapeutic management such as mucosal resection or, especially, endoscopic submucosal dissection. This may replace panproctocolectomy in selected patients. The authors review the potential of these techniques to transform endoscopic diagnosis and therapeutic management of dysplasia in IBD.

Su1453 Evaluation of Wide-Area Transepithelial Sampling (Wats-3D) Brush Biopsy and Standard Forceps Biopsy (FB) for the Surveillance of Barrett's Dysplasia or Neoplasia After Endoscopic Therapy

Evaluation of Wide-Area Transepithelial Sampling (Wats-3D) Brush Biopsy and Standard Forceps Biopsy (FB) for the Surveillance of Barrett’s Dysplasia or Neoplasia After Endoscopic Therapy Danielle Marino*, Donald N. Tsynman, Vivek Kaul Gastroenterology, University of Rochester Medical Center, Rochester, NY Background: Endoscopic ablation is the standard treatment for Barrett’s esophagus (BE) with dysplasia. Post-ablation, the current standard includes surveillance endoscopy with four-quadrant FB every1-2cm of neo-squamous epithelium. However, dysplasia can be patchy in distribution and may be missed with standard FB protocol. A novel tissue sampling device, the WATS-3D computer-assisted brush-biopsy was developed to overcome sampling related limitations. It obtains a sample of the entire thickness of the squamous or glandular epithelium down to the lamina propria. A computer-assisted scan pinpoints potentially abnormal cells for presentation to a pathologist. This study serves to examine the incremental value of WATS sampling over standard FB for Barrett’s and dysplasia surveillance in patients after endoscopic ablation for dysplastic Barrett’s. Materials And Methods: In this pilot study, 13 charts were reviewed retrospectively over a 2 month period to identify patients with a history of BE with dysplasia or neoplasia who had previously undergone endoscopic therapy (mucosal resection, radiofrequency ablation or cryotherapy), and had a follow-up endoscopy with both standard biopsy and WATS. Demographic data, social/medical history and tissue sampling results from both modalities were collected. WATS results were compared for both concordance and discordance with standard pathology results. Study was IRB approved. Results: 12 patients met all inclusion criteria. One of the WATS samples was inadequate for interpretation, and thus 11 patients are included in the final analysis. The mean patient age was 79 years; 91% were male, 91% were Caucasian. 55% had long segment and 45% had short segment BE prior to therapy. Prior to endoscopic therapy, 6 patients had low-grade dysplasia (LGD), 5 patients had high-grade dysplasia (HGD), 1 patient had both LGD and HGD and 3 patients had intramucosal carcinoma. On follow-up endoscopy, 2 patients had residual BE on both WATS and FB specimens. 3 patients were diagnosed with BE on WATS only, (1 of these also had LGD by WATS only). No patients were diagnosed with BE on FB only. One patient was diagnosed with LGD on FB only, and one was diagnosed with HGD on FB only; both of the WATS samples showed nondysplastic BE. Overall, WATS increased the yield for BE and/or dysplasia in 27% (3/11) patients. There were no complications. Conclusions: In this pilot study of post endoscopic therapy surveillance, WATS increased the detection rate for BE and/or dysplasia by 27% when used as an adjunctive technique to 4 quadrant FB. However, FB did reveal dysplasia in 2 patients in which WATS was “normal”. Prospective studies, larger patient cohorts and standardized sampling protocols are needed to further assess this promising new technology.

Surveillance for Dysplasia in Patients with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Interim Analysis

The risk of developing cancer in the ileal pouch of patients with surgery for ulcerative colitis has not been defined. Dysplasia in the pouch is quite rare. Although some suggest pouch surveillance based on previous histological assessments, there are no guidelines for surveillance of these patients. The aim of our study was to investigate that risk and identify time intervals for ileoanal pouch surveillance. Endoscopy and biopsies of the ileal pouch were performed at 3, 6, and/or 12 months after ileal pouch-anal anastomosis (IPAA) became functional. Biopsies were evaluated by two pathologists using Riddel's criteria. Interim data analysis using descriptive statistics is reported. Thirty-eight patients have entered the study. Average patient age at 3, 6, and 12 months of surveillance was 39.1, 36.8, and 39.1 years, respectively. Average disease duration was 8.2 years. Ten of 38 cases (26%) had colonic dysplasia prior to surgery. Dysplasia within the pouch was reported in one patient 6 months after IPAA became functional. This patient demonstrated no dysplasia at 12 months or statistical divergence by age, duration of disease or history of colonic dysplasia prior to IPAA. No subgroup of patients with dysplasia was identified to calculate cumulative risk or perform comparative statistical analysis. A study with longer follow-up after IPAA should precede any attempt to recommend routine surveillance. However, the finding of dysplasia early after surgery underscores the importance of early pouch surveillance in our population, at least until definite predisposing variables are identified.

Colitis-associated cancer and dysplasia surveillance: An opposing perspective

Gastroenterologists have an understandable fear of missing colorectal cancer in any patient under their care. In patients with an increased risk of colorectal cancer, it is instinctive and perhaps intuitive for gastroenterologists to search the colon frequently for early markers of cancer risk. This would appear to be supported by various consensus statements and published guidelines on dysplasia surveillance. However, there are opposing viewpoints, and the practice of dysplasia surveillance in patients with ulcerative colitis has been questioned in terms of its efficacy and cost effectiveness.

Mesalamine Prevents Dysplasia in Patients with Inflammatory Bowel Disease

Purpose: The lifetime prevalence of colorectal cancer in a patients with inflammatory bowel disease (IBD), ulcerative colitis or Crohn's colitis, is 3 to 6%. Endoscopic surveillance for dysplasia in patients with long-standing colitis is an accepted method of preventing death from colorectal cancer. Recent studies have suggested that the incidence of colorectal cancer in patients with long-standing colitis is decreasing. It is not clear whether the decrease in colorectal cancer is associated with a decrease in the incidence of dysplasia, to changes in the natural history of the disease or increased use of maintance therapy with mesalamine and/or immunosuppressive agents. Methods: In order to determine the role of mesalamine in the prevention of colon cancer, we evaluated mesalamine use in patients with long-standing ulcerative colitis and Crohn's colitis who had a duration of disease greater than 8 years. Demographic information, duration of disease, number of flares, hospitalizations, extent of disease, and other medications taken were recorded. The mean dosage of mesalamine was calculated using the total dose per time period studied divided by the number of days from the time of diagnosis to May 1, 2005. Results: One hundred-two patients were included in the study. There were 53 female, 49 male patients, mean age 64 ± 18 years. The mean duration of disease was 16.5 ± 8.8 years. All patients had received mesalamine for a mean period of 14.4 ± 7.1 years. The mean dosage of mesalamine in all patients was 2.6 ± 1.2 grams. None of the patients studied developed colon cancer. Four patients developed dysplasia (3.9%). The mean dosage of mesalamine in patients who had not developed dysplasia 2.6 ± 1.2 grams was significantly higher than patients who had developed dysplasia 0.8 ± 0.35 grams (p = 0.003). There were no significant differences between the groups regarding age, gender, duration of disease, extent of disease, or other medications, including 6-mercaptopurine/azathioprine. Conclusions: We conclude that the incidence of dysplasia and colon cancer in patients with IBD is decreasing. In patients with long-standing IBD, increased total mesalamine exposure appears to decrease the incidence of dysplasia. These results suggest that the decreased incidence of colon cancer in patients with IBD may be related to increased use of mesalamine for maintainance therapy.

Surveillance for Dysplasia in Patients with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Surveillance for Dysplasia in Patients with Ileal Pouch-Anal Anastomosis for Ulcerative Colitis