Clinical implications of low grade dysplasia found during inflammatory bowel disease surveillance: a retrospective study comparing chromoendoscopy and white-light endoscopy

Joren R. ten Hove; Erik Mooiweer; Andrea E. van der Meulen de Jong; Evelien Dekker; Cyriel Y. Ponsioen; Peter D. Siersema; Bas Oldenburg

doi:10.1055/s-0042-119394

Endoscopy, Table of Contents

Endoscopy 2017; 49(02): 161-168
DOI: 10.1055/s-0042-119394

Original article

Clinical implications of low grade dysplasia found during inflammatory bowel disease surveillance: a retrospective study comparing chromoendoscopy and white-light endoscopy

Joren R. ten Hove

¹Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

,

Erik Mooiweer

¹Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

,

Andrea E. van der Meulen de Jong

²Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands

,

Evelien Dekker

³Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands

,

Cyriel Y. Ponsioen

³Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands

,

Peter D. Siersema

¹Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

⁴Department of Gastroenterology and Hepatology, Radboud University Medical Center, Utrecht, Nijmegen, The Netherlands

,

Bas Oldenburg

¹Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

› Author Affiliations

Abstract

Background and study aims Current guidelines recommend the use of pancolonic chromoendoscopy for surveillance of patients with inflammatory bowel disease (IBD). It is currently unknown whether low grade dysplasia (LGD) found using chromoendoscopy carries a similar risk of high grade dysplasia (HGD) or colorectal cancer (CRC) compared with LGD detected using white-light endoscopy (WLE). The aim of this study was to compare the risk of advanced neoplasia, a combined endpoint of HGD and CRC, during follow-up after detection of lesions containing LGD identified with either chromoendoscopy or WLE.

Patients and methods A retrospective cohort was established to identify patients who underwent IBD surveillance for ulcerative colitis or colonic Crohn’s disease between 2000 and 2014. Subgroups were identified, based on the endoscopic technique (standard definition resolution WLE, high definition resolution WLE or chromoendoscopy). LGD detected in random biopsies was considered invisible LGD. Patients were followed until detection of advanced neoplasia, colectomy, death, or the last known surveillance colonoscopy.

Results Of 1065 patients undergoing IBD surveillance, 159 patients underwent follow-up for LGD, which was visible in 133 cases and invisible in 26 cases. On follow-up, five cases of HGD and five cases of CRC were detected. The overall incidence rate of advanced neoplasia was 1.34 per 100 patient-years with a median follow-up of 4.7 years and a median time to advanced neoplasia of 3.3 years. There were no significant differences in the incidence of advanced neoplasia between chromoendoscopy-detected and WLE-detected LGD.

Conclusion Advanced neoplasia was found to develop infrequently after detection of LGD in patients undergoing endoscopic surveillance for IBD. LGD lesions detected with either chromoendoscopy or WLE carry similar risks of advanced neoplasia over time.

Full Text

References

References
1 Bernstein CN, Blanchard JF, Kliewer E. et al. Cancer risk in patients with inflammatory bowel disease: a population-based study. Cancer 2001; 91: 854-862
2 Soetikno RM, Lin OS, Heidenreich PA. et al. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis. Gastrointest Endosc 2002; 56: 48-54
3 Choi C-HR, Rutter MD, Askari A. et al. Forty-year analysis of colonoscopic surveillance program for neoplasia in ulcerative colitis: an updated overview. Am J Gastroenterol 2015; 110: 1022-1034
4 Lutgens MWMD, van Oijen MGH, van der Heijden GJMG. et al. Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis 19: 789-799
5 Jess T, Simonsen J, Jørgensen KT. et al. Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years. Gastroenterology 2012; 143: 375-381.e1 ; quiz e13–e14
6 Eaden JA, Abrams KR, Mayberry JF. The risk of colorectal cancer in ulcerative colitis: a meta-analysis. Gut 2001; 48: 526-535
7 Feagins LA, Souza RF, Spechler SJ. Carcinogenesis in IBD: potential targets for the prevention of colorectal cancer. Nat Rev Gastroenterol Hepatol 2009; 6: 297-305
8 Riddell RH, Goldman H, Ransohoff DF. et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol 1983; 14: 931-968
9 Cairns SR, Scholefield JH, Steele RJ. et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666-689
10 Marion JF, Waye JD, Israel Y. et al. Chromoendoscopy is more effective than standard colonoscopy in detecting dysplasia during long-term surveillance of patients with colitis. Clin Gastroenterol Hepatol 2016; 14: 713-719
11 Subramanian V, Mannath J, Ragunath K. et al. Meta-analysis: the diagnostic yield of chromoendoscopy for detecting dysplasia in patients with colonic inflammatory bowel disease. Aliment Pharmacol Ther 2011; 33: 304-312
12 Kiesslich R, Fritsch J, Holtmann M. et al. Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology 2003; 124: 880-888
13 Mooiweer E, van der Meulen-de Jong AE, Ponsioen CY. et al. Chromoendoscopy for surveillance in inflammatory bowel disease does not increase neoplasia detection compared with conventional colonoscopy with random biopsies: results from a large retrospective study. Am J Gastroenterol 2015; 110: 1014-1021
14 Venkatesh PGK, Jegadeesan R, Gutierrez NG. et al. Natural history of low grade dysplasia in patients with primary sclerosing cholangitis and ulcerative colitis. J Crohn’s Colitis 2013; 7: 968-973
15 Zisman TL, Bronner MP, Rulyak S. et al. Prospective study of the progression of low-grade dysplasia in ulcerative colitis using current cancer surveillance guidelines. Inflamm Bowel Dis 2012; 18: 2240-2246
16 Thomas T, Abrams KA, Robinson RJ. et al. Meta-analysis: cancer risk of low-grade dysplasia in chronic ulcerative colitis. Aliment Pharmacol Ther 2007; 25: 657-668
17 Navaneethan U, Jegadeesan R, Gutierrez NG. et al. Progression of low-grade dysplasia to advanced neoplasia based on the location and morphology of dysplasia in ulcerative colitis patients with extensive colitis under colonoscopic surveillance. J Crohns Colitis 2013; 7: e684-e691
18 Choi C-HR, Ignjatovic-Wilson A, Askari A. et al. Low-grade dysplasia in ulcerative colitis: risk factors for developing high-grade dysplasia or colorectal cancer. Am J Gastroenterol 2015; 110: 1461-1471
19 Wanders LK, Dekker E, Pullens B. et al. Cancer risk after resection of polypoid dysplasia in patients with longstanding ulcerative colitis: a meta-analysis. Clin Gastroenterol Hepatol 2014; 12: 756-764
20 Goldstone R, Itzkowitz S, Harpaz N. et al. Progression of low-grade dysplasia in ulcerative colitis: effect of colonic location. Gastrointest Endosc 2011; 74: 1087-1093
21 Lai KK, Horvath B, Xie H. et al. Risk for colorectal neoplasia in patients with inflammatory bowel disease and mucosa indefinite for dysplasia. Inflamm Bowel Dis 2015; 21: 378-384
22 Van Schaik FDM, ten Kate FJW, Offerhaus GJA. et al. Misclassification of dysplasia in patients with inflammatory bowel disease: consequences for progression rates to advanced neoplasia. Inflamm Bowel Dis 2011; 17: 1108-1116
23 Marion JF, Sands BE. The SCENIC consensus statement on surveillance and management of dysplasia in inflammatory bowel disease: praise and words of caution. Gastroenterology 2015; 148: 462-467
24 Leedham SJ, Graham TA, Oukrif D. et al. Clonality, founder mutations, and field cancerization in human ulcerative colitis-associated neoplasia. Gastroenterology 2009; 136: 542-550
25 Lim CH, Dixon MF, Vail A. et al. Ten year follow up of ulcerative colitis patients with and without low grade dysplasia. Gut 2003; 52: 1127-1132
26 Befrits R, Ljung T, Jaramillo E. et al. Low-grade dysplasia in extensive, long-standing inflammatory bowel disease: a follow-up study. Dis Colon Rectum 2002; 45: 615-620
27 Blackstone MO, Riddell RH, Rogers BH. et al. Dysplasia-associated lesion or mass (DALM) detected by colonoscopy in long-standing ulcerative colitis: an indication for colectomy. Gastroenterology 1981; 80: 366-374
28 Mooiweer E, van der Meulen-de Jong AE, Ponsioen CY. et al. Incidence of interval colorectal cancer among inflammatory bowel disease patients undergoing regular colonoscopic surveillance. Clin Gastroenterol Hepatol 2015; 13: 1656-1661
29 Rutter MD. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004; 53: 1813-1816