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Mahmoud R, Shah SC, ten Hove JR, Torres J, Mooiweer E, Castaneda D, Glass J, Elman J, Kumar A, Axelrad J, Ullman T, Colombel JF, Oldenburg B, Itzkowitz SH. No Association Between Pseudopolyps and Colorectal Neoplasia in Patients With Inflammatory Bowel Diseases. Gastroenterology 2019; 156:1333-1344.e3. [PMID: 30529584 PMCID: PMC7354096 DOI: 10.1053/j.gastro.2018.11.067] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 11/21/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Patients with inflammatory bowel diseases who have postinflammatory polyps (PIPs) have an increased risk of colorectal neoplasia (CRN). European guidelines propose that patients with PIPs receive more frequent surveillance colonoscopies, despite limited evidence of this increased risk. We aimed to define the risk of CRN and colectomy in patients with inflammatory bowel diseases and PIPs. METHODS We conducted a multicenter retrospective cohort study of patients with inflammatory bowel diseases who underwent colonoscopic surveillance for CRN, from January 1997 through January 2017, at 5 academic hospitals and 2 large nonacademic hospitals in New York or the Netherlands. Eligible patients had confirmed colonic disease with duration of at least 8 years (or any duration, if they also had primary sclerosing cholangitis) and no history of advanced CRN (high-grade dysplasia or colorectal cancer) or colectomy. The primary outcome was occurrence of advanced CRN according to PIP status; secondary outcomes were occurrence of CRN (inclusive of low-grade dysplasia) and colectomy. RESULTS Of 1582 eligible patients, 462 (29.2%) had PIPs. PIPs were associated with more severe inflammation (adjusted odds ratio 1.32; 95% confidence interval [CI] 1.13-1.55), greater disease extent (adjusted odds ratio 1.92; 95% CI 1.34-2.74), and lower likelihood of primary sclerosing cholangitis (adjusted odds ratio 0.38; 95% CI 0.26-0.55). During a median follow-up period of 4.8 years, the time until development of advanced CRN did not differ significantly between patients with and those without PIPs. PIPs did not independently increase the risk of advanced CRN (adjusted hazard ratio 1.17; 95% CI 0.59-2.31). The colectomy rate was significantly higher in patients with PIPs (P = .01). CONCLUSIONS In a retrospective analysis of data from 2 large independent surveillance cohorts, PIPs were associated with greater severity and extent of colon inflammation and higher rates of colectomy, but were not associated with development of any degree of CRN. Therefore, intervals for surveillance should not be shortened based solely on the presence of PIPs.
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Affiliation(s)
- Remi Mahmoud
- Department of Gastroenterology and Hepatology, University
Medical Center Utrecht, Utrecht, The Netherlands.,Division of Gastroenterology, Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shailja C. Shah
- Division of Gastroenterology, Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Gastroenterology, Hepatology and Nutrition,
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,
USA
| | - Joren R. ten Hove
- Department of Gastroenterology and Hepatology, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Joana Torres
- Division of Gastroenterology, Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Gastroenterology, Surgical Department,
Hospital Beatriz Ângelo, Loures, Portugal
| | - Erik Mooiweer
- Department of Gastroenterology and Hepatology, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniel Castaneda
- Division of Gastroenterology, Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jason Glass
- Division of Gastroenterology, Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordan Elman
- Department of Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Akash Kumar
- Division of Gastroenterology, Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordan Axelrad
- Division of Digestive and Liver Diseases, Department of
Medicine, Columbia University Medical Center, New York, NY, USA
| | - Thomas Ullman
- Division of Gastroenterology, Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven H. Itzkowitz
- Division of Gastroenterology, Department of Medicine,
Icahn School of Medicine at Mount Sinai, New York, NY, USA
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