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Serrated Epithelial Change in Ulcerative Colitis Patients is Associated with High Rate of Colonic Dysplasia
AGA Abstracts
Table 1. Patient Characteristics
versus 21%, p=0.8, Table 1), the rate of developing aCRN following detection of LGD was higher in PSC-IBD patients (HR 2.8, 95% CI 1.2-6.5). The incidence rate of aCRN after a diagnosis of LGD was 7.4/100pty for PSC-IBD patients compared to 2.3/100pty for nonPSC IBD patients. Using Cox-regression analysis, older age at study entry and a history of prior neoplasia were significant risk factors for development of CRN (LGD, or HGD, or CRC) among PSC-IBD patients; there was a non-significant trend for an association of multifocal dysplasia with higher risk of developing aCRN after an LGD diagnosis (HR 3.2, 95%CI 0.8-11.8, p=0.086). Conclusions: PSC-IBD patients have a similar incidence of LGD compared to non-PSC IBD patients, but the risk of developing aCRN after a diagnosis of LGD is significantly higher in PSC-IBD patients. Our findings substantiate recommendations for annual surveillance in this very high-risk population.
Table 1 - Advanced colorectal neoplasia (aCRN) and low-grade dysplasia (LGD) development rates among PSC-IBD patients and non-PSC IBD UC - ulcerative colitis, SEC - serrated epithelial changes, LGD - low-grade dysplasia, HGD - high-grade dysplasia, CRC - colorectal cancer
301 ZERO DIAGNOSTIC YIELD OF DYSPLASIA IN POLYP ADJACENT BIOPSIES FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE Conor J. Lahiff, Lai Mun Wang, Simon P. Travis, James East Background: Patients with inflammatory bowel disease (IBD) undergoing colonoscopic polypectomy are recommended by current guidelines (ECCO, 20131; AGA & ASGE 2015 [SCENIC]2) to have biopsies taken from the area immediately adjacent to the resected polyp to determine whether there is adjacent dysplasia present. With improvements in endoscopic imaging technology and use of pan-colonic dye spray, as recommended by the same guidelines, it is possible to characterise colonic lesions with higher levels of confidence than previously. We reviewed the diagnostic yield of such adjacent biopsies over a recent five year period. Methods: A systematic search of our histopathology database revealed cases where polyps had been endoscopically resected or biopsied in patients with IBD between January 2010 and December 2015. Endoscopy reports and medical records were reviewed and patient demographic and disease specific details were recorded, along with details of polyp characteristics and histopathology outcomes. Results: Over a five year period, 302 polyps were biopsied or resected in 131 patients undergoing 178 colonoscopic examinations. Median patient age was 60 (range 17-82), with 43% female. One hundred and twenty three patients (92%) had ulcerative colitis, 6 Crohn's colitis and 2 IBD-unclassified. Thirty patients (23%) had PSC. Median disease duration was 20 years (range 1-58 years). The majority of patients were on ASA based monotherapy. On a per-procedure analysis, 71 patients (40%) underwent chromoendoscopy, while 49 (28%) had their examinations with a high-definition colonoscope. On a per polyp analysis, median size was 4mm (range 1-45) and the predominant morphology was Paris 0-Is (sessile, n=98, 32%). Histology was tubular adenoma in 76 (25%), tubulovillous adenoma in 14 (5%), hyperplastic in 112 (37%), post-inflammatory in 32 (11%), sessile serrated polyp in 31 (10%), traditional serrated adenoma in 2 (0.7%), high-grade dysplasia or cancer in 2 (0.7%) and other in 33 (11%). Inflammation in adjacent biopsies was present in 34 patients (11%). Dysplasia in adjacent biopsies was detected in 2 patients (0.7%) and was endoscopically visible in both cases. Therefore the proportion of endoscopically unsuspected dysplasia revealed by adjacent biopsies was 0/300 (0%, 95% CI 0-1.6%) Conclusion: The diagnostic yield for polyp adjacent biopsies in patients with IBD is negligible. We suggest that with contemporary use of high definition technology and chromoendoscopy it is no longer necessary to biopsy endoscopically normal adjacent tissue to detect invisible dysplasia. References: 1 Annese et al. J Crohn's Colitis 2013 2 Laine et al. Gastroenterology 2015
Figure 1. aCRN incidence comparison between PSC IBD and non-PSC IBD patients.
300 SERRATED EPITHELIAL CHANGE IN ULCERATIVE COLITIS PATIENTS IS ASSOCIATED WITH HIGH RATE OF COLONIC DYSPLASIA Alyssa M. Parian, Reezwana Chowdhury, David T. Rubin, Mohammed A. Razvi, Brindusa Truta, Joanna P. Melia, Maryam Kherad Pezhouh, Sharon Dudley-Brown, Steven R. Brant, Mark Lazarev Introduction: Serrated epithelial change (SEC) is a histological finding in patients with chronic ulcerative colitis (UC), which is distinct from serrated adenomas. The association between SEC and colonic neoplasia is controversial. We aim to determine if SEC is associated with a higher rate of colonic dysplasia in UC patients. Methods: A matched case-control study was performed to compare UC patients with SEC to UC patients without SEC. Patients were identified from the Johns Hopkins Pathology Database from 2000 - 2008. UC-SEC patients were matched to at least one control patient with UC and without SEC. Patients were matched on age (+/-5 years), disease duration (+/- 5 years), and disease extent (E1 proctitis, E2 - left sided, or E3 - extensive). The rate of colonic dysplasia and time to incident dysplasia was compared in UC patients with SEC to UC patients without SEC. Follow-up time was measured from index scope until last follow up or incident colonic dysplasia. Results: We identified 64 UC patients with SEC and matched them to 113 UC patients without SEC. The number of pathology specimens per patient was similar between the two groups. UC patients with SEC had a significantly higher rate of colonic dysplasia than UC patients without SEC (23.4% vs. 5.3%) despite similar ages, disease duration and disease extent (Table 1). The rate of low-grade dysplasia (LGD) was significantly higher in UC patients with SEC. The rates of high-grade dysplasia (HGD) and colorectal cancer (CRC) were not significantly different between cases and controls. The time from index scope to the incident dysplasia was significantly shorter in the SEC group. UC patients without SEC had a longer follow-up time than UC patients with SEC. Conclusion: When controlling for disease duration, disease extent and age, UC patients with SEC have a higher risk of colonic dysplasia than UC patients without SEC. These findings support more intensive surveillance in UC patients with a history of SEC.
AGA Abstracts
302 RISK OF MYOCARDIAL INFARCTION AND CONGESTIVE HEART FAILURE IN INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED INCEPTION COHORT STUDY Satimai Aniwan, Véronique Roger, Darrell S. Pardi, William J. Tremaine, Edward V. Loftus Background: Although an increased risk of coronary heart disease (CHD) in chronic systemic inflammatory diseases such as rheumatoid arthritis is well documented, it is unclear whether inflammatory bowel disease (IBD) increases the risk of clinical CHD. We sought to examine the risk of myocardial infarction (MI) and congestive heart failure (CHF) in patients with IBD compared with age- and sex-matched controls. Methods: We performed a populationbased cohort study of patients, age ≥ 18 years, first diagnosed with IBD within a defined geographic region of the U.S. between 1980 and 2010. For each IBD patient, two controls from the same region were randomly selected after matching for age-, sex- and index date of IBD diagnosis. IBD patients and controls who had a history of MI or CHF prior to the index date were excluded. All patients were followed from diagnosis until MI, CHF, death, emigration, or the end of the study (30 June 2016). The primary outcomes were development of MI and/or CHF events. Traditional risk factors of coronary heart disease (CHD) including family history of heart disease, current smoking, diabetes, hypertension, dyslipidemia, and body mass index (BMI) were assessed. Incidence rate and incidence rate ratio (IRR) were
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Table 1. Patient Characteristics
versus 21%, p=0.8, Table 1), the rate of developing aCRN following detection of LGD was higher in PSC-IBD patients (HR 2.8, 95% CI 1.2-6.5). The incidence rate of aCRN after a diagnosis of LGD was 7.4/100pty for PSC-IBD patients compared to 2.3/100pty for nonPSC IBD patients. Using Cox-regression analysis, older age at study entry and a history of prior neoplasia were significant risk factors for development of CRN (LGD, or HGD, or CRC) among PSC-IBD patients; there was a non-significant trend for an association of multifocal dysplasia with higher risk of developing aCRN after an LGD diagnosis (HR 3.2, 95%CI 0.8-11.8, p=0.086). Conclusions: PSC-IBD patients have a similar incidence of LGD compared to non-PSC IBD patients, but the risk of developing aCRN after a diagnosis of LGD is significantly higher in PSC-IBD patients. Our findings substantiate recommendations for annual surveillance in this very high-risk population.
Table 1 - Advanced colorectal neoplasia (aCRN) and low-grade dysplasia (LGD) development rates among PSC-IBD patients and non-PSC IBD UC - ulcerative colitis, SEC - serrated epithelial changes, LGD - low-grade dysplasia, HGD - high-grade dysplasia, CRC - colorectal cancer
301 ZERO DIAGNOSTIC YIELD OF DYSPLASIA IN POLYP ADJACENT BIOPSIES FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE Conor J. Lahiff, Lai Mun Wang, Simon P. Travis, James East Background: Patients with inflammatory bowel disease (IBD) undergoing colonoscopic polypectomy are recommended by current guidelines (ECCO, 20131; AGA & ASGE 2015 [SCENIC]2) to have biopsies taken from the area immediately adjacent to the resected polyp to determine whether there is adjacent dysplasia present. With improvements in endoscopic imaging technology and use of pan-colonic dye spray, as recommended by the same guidelines, it is possible to characterise colonic lesions with higher levels of confidence than previously. We reviewed the diagnostic yield of such adjacent biopsies over a recent five year period. Methods: A systematic search of our histopathology database revealed cases where polyps had been endoscopically resected or biopsied in patients with IBD between January 2010 and December 2015. Endoscopy reports and medical records were reviewed and patient demographic and disease specific details were recorded, along with details of polyp characteristics and histopathology outcomes. Results: Over a five year period, 302 polyps were biopsied or resected in 131 patients undergoing 178 colonoscopic examinations. Median patient age was 60 (range 17-82), with 43% female. One hundred and twenty three patients (92%) had ulcerative colitis, 6 Crohn's colitis and 2 IBD-unclassified. Thirty patients (23%) had PSC. Median disease duration was 20 years (range 1-58 years). The majority of patients were on ASA based monotherapy. On a per-procedure analysis, 71 patients (40%) underwent chromoendoscopy, while 49 (28%) had their examinations with a high-definition colonoscope. On a per polyp analysis, median size was 4mm (range 1-45) and the predominant morphology was Paris 0-Is (sessile, n=98, 32%). Histology was tubular adenoma in 76 (25%), tubulovillous adenoma in 14 (5%), hyperplastic in 112 (37%), post-inflammatory in 32 (11%), sessile serrated polyp in 31 (10%), traditional serrated adenoma in 2 (0.7%), high-grade dysplasia or cancer in 2 (0.7%) and other in 33 (11%). Inflammation in adjacent biopsies was present in 34 patients (11%). Dysplasia in adjacent biopsies was detected in 2 patients (0.7%) and was endoscopically visible in both cases. Therefore the proportion of endoscopically unsuspected dysplasia revealed by adjacent biopsies was 0/300 (0%, 95% CI 0-1.6%) Conclusion: The diagnostic yield for polyp adjacent biopsies in patients with IBD is negligible. We suggest that with contemporary use of high definition technology and chromoendoscopy it is no longer necessary to biopsy endoscopically normal adjacent tissue to detect invisible dysplasia. References: 1 Annese et al. J Crohn's Colitis 2013 2 Laine et al. Gastroenterology 2015
Figure 1. aCRN incidence comparison between PSC IBD and non-PSC IBD patients.
300 SERRATED EPITHELIAL CHANGE IN ULCERATIVE COLITIS PATIENTS IS ASSOCIATED WITH HIGH RATE OF COLONIC DYSPLASIA Alyssa M. Parian, Reezwana Chowdhury, David T. Rubin, Mohammed A. Razvi, Brindusa Truta, Joanna P. Melia, Maryam Kherad Pezhouh, Sharon Dudley-Brown, Steven R. Brant, Mark Lazarev Introduction: Serrated epithelial change (SEC) is a histological finding in patients with chronic ulcerative colitis (UC), which is distinct from serrated adenomas. The association between SEC and colonic neoplasia is controversial. We aim to determine if SEC is associated with a higher rate of colonic dysplasia in UC patients. Methods: A matched case-control study was performed to compare UC patients with SEC to UC patients without SEC. Patients were identified from the Johns Hopkins Pathology Database from 2000 - 2008. UC-SEC patients were matched to at least one control patient with UC and without SEC. Patients were matched on age (+/-5 years), disease duration (+/- 5 years), and disease extent (E1 proctitis, E2 - left sided, or E3 - extensive). The rate of colonic dysplasia and time to incident dysplasia was compared in UC patients with SEC to UC patients without SEC. Follow-up time was measured from index scope until last follow up or incident colonic dysplasia. Results: We identified 64 UC patients with SEC and matched them to 113 UC patients without SEC. The number of pathology specimens per patient was similar between the two groups. UC patients with SEC had a significantly higher rate of colonic dysplasia than UC patients without SEC (23.4% vs. 5.3%) despite similar ages, disease duration and disease extent (Table 1). The rate of low-grade dysplasia (LGD) was significantly higher in UC patients with SEC. The rates of high-grade dysplasia (HGD) and colorectal cancer (CRC) were not significantly different between cases and controls. The time from index scope to the incident dysplasia was significantly shorter in the SEC group. UC patients without SEC had a longer follow-up time than UC patients with SEC. Conclusion: When controlling for disease duration, disease extent and age, UC patients with SEC have a higher risk of colonic dysplasia than UC patients without SEC. These findings support more intensive surveillance in UC patients with a history of SEC.
AGA Abstracts
302 RISK OF MYOCARDIAL INFARCTION AND CONGESTIVE HEART FAILURE IN INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED INCEPTION COHORT STUDY Satimai Aniwan, Véronique Roger, Darrell S. Pardi, William J. Tremaine, Edward V. Loftus Background: Although an increased risk of coronary heart disease (CHD) in chronic systemic inflammatory diseases such as rheumatoid arthritis is well documented, it is unclear whether inflammatory bowel disease (IBD) increases the risk of clinical CHD. We sought to examine the risk of myocardial infarction (MI) and congestive heart failure (CHF) in patients with IBD compared with age- and sex-matched controls. Methods: We performed a populationbased cohort study of patients, age ≥ 18 years, first diagnosed with IBD within a defined geographic region of the U.S. between 1980 and 2010. For each IBD patient, two controls from the same region were randomly selected after matching for age-, sex- and index date of IBD diagnosis. IBD patients and controls who had a history of MI or CHF prior to the index date were excluded. All patients were followed from diagnosis until MI, CHF, death, emigration, or the end of the study (30 June 2016). The primary outcomes were development of MI and/or CHF events. Traditional risk factors of coronary heart disease (CHD) including family history of heart disease, current smoking, diabetes, hypertension, dyslipidemia, and body mass index (BMI) were assessed. Incidence rate and incidence rate ratio (IRR) were
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