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Dysplastic Progression to Adenocarcinoma is Equivalent in Ulcerative Colitis and Crohn's disease.

A. Lightner,S. Vogler,J. McMichael,X. Jia,M. Regueiro,T. Qazi,S. Steele

Published 2020 in Journal of Crohn's & Colitis

ABSTRACT

BACKGROUND We sought to determine the rate of progression from dysplasia to adenocarcinoma in UC versus CD and describe risk factors unique to each. METHODS All adult patients (> 18 years) with a known diagnosis of either UC or CD who underwent a surveillance colonoscopy between January 1, 2010 and January 1, 2020 were included. RESULTS A total of 23,751 surveillance colonoscopies were performed among 12,289 between 1/1/2010 and 1/1/2020; 6909 (56.2%) had a diagnosis of CD and 5380 (43.8%) had a diagnosis of UC. There were a total of 668 patients (5.4%) with low grade dysplasia (LGD), 76 patients (0.62%) high grade dysplasia (HGD), and 68 patients (0.55%) adenocarcinoma in the series; the majority of the dysplastic events were located in the right colon. Significantly more UC patients had a dysplastic event, but the rate of LGD and HGD dysplasia progression to adenocarcinoma was not significantly different in CD or UC (p=0.682 and p=1.0, respectively) There was no significant difference in the rate of progression from LGD/HGD to adenocarcinoma based on random biopsies versus targeted biopsies of visible lesions (p=0.37). However, the rate of progression from LGD versus HGD to adenocarcinoma was significantly greater for HGD (p<0.001). CONCLUSION While more UC patients are found to have neoplasia on colonoscopy, the rate of progression from LGD and HGD to adenocarcinoma is equivalent in UC and CD suggesting that endoscopic surveillance strategies can remain consistent for all IBD patients.

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