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Nearly a Third of High-Grade Dysplasia and Colorectal Cancer Is Undetected in Patients with Inflammatory Bowel Disease

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Abstract

Background

It is unclear whether intensive surveillance protocols have resulted in a decreased incidence of colorectal cancer (CRC) in inflammatory bowel disease (IBD).

Aims

To determine the prevalence and characteristics of IBD associated high-grade dysplasia (HGD) or CRC that was undetected on prior colonoscopy.

Methods

This is a single-center, retrospective study from 1994 to 2013. All participants had a confirmed IBD diagnosis and underwent a colectomy with either HGD or CRC found in the colectomy specimen.The undetected group had no HGD or CRC on prior colonoscopies. The detected group had HGD or CRC identified on previous biopsies.

Results

Of 70 participants, with ulcerative colitis (UC) (n = 47), Crohn’s disease (CD) (n = 21), and indeterminate colitis (n = 2), 29% (n = 20) had undetected HGD/CRC at colectomy (15 HGD and 5 CRC). In the undetected group, 75% had prior LGD, 15% had indefinite dysplasia, and 10% had no dysplasia (HGD was found in colonic strictures). Patients in the undetected group were more likely to have pancolitis (55 vs. 20%) and multifocal dysplasia (35 vs. 8%). The undetected group was less likely to have CRC at colectomy (25 vs. 62%). There was a trend toward right-sided HGD/CRC at colectomy (40 vs. 20%; p = 0.08). In addition, 84% of the lesions found in the rectum at colectomy were not seen on prior colonoscopy in the undetected group.

Conclusions

The prevalence of previously undetected HGD/CRC in IBD found at colectomy was 29%. The high proportion of undetected rectal and right-sided HGD/CRC suggests that these areas may need greater attention during surveillance.

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Acknowledgments

This study was funded in part by the National Institute for Diabetes and Digestive and Kidney Diseases Grant T32DK07634 and DK190040.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina at Chapel Hill, 4119B Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, 27599-7080, USA

    Swathi Eluri, Alyssa M. Parian, Steven R. Brant, Sharon Dudley-Brown, Jonathan E. Efron, Sandy G. Fang, Susan L. Gearhart, Michael R. Marohn, Stephen J. Meltzer, Safar Bashar, Brindusa Truta, Elizabeth A. Montgomery & Mark G. Lazarev

  2. Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Swathi Eluri

  3. Stanford University School of Medicine, Stanford, CA, USA

    Berkeley N. Limketkai

  4. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Christina Y. Ha

  5. Digestive Health Liver Clinic, 900 Blake Wilbur Dr, MC 5355, Palo Alto, CA, 94304, USA

    Berkeley N. Limketkai

  6. Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA, 90095, USA

    Christina Y. Ha

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  1. Swathi Eluri
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  2. Alyssa M. Parian
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  3. Berkeley N. Limketkai
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  4. Christina Y. Ha
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  5. Steven R. Brant
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  7. Jonathan E. Efron
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  8. Sandy G. Fang
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  9. Susan L. Gearhart
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  10. Michael R. Marohn
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  11. Stephen J. Meltzer
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  12. Safar Bashar
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  13. Brindusa Truta
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  14. Elizabeth A. Montgomery
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Corresponding author

Correspondence to Swathi Eluri.

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The authors declare that they have no conflict of interest.

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Eluri, S., Parian, A.M., Limketkai, B.N. et al. Nearly a Third of High-Grade Dysplasia and Colorectal Cancer Is Undetected in Patients with Inflammatory Bowel Disease. Dig Dis Sci 62, 3586–3593 (2017). https://doi.org/10.1007/s10620-017-4652-5

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  • DOI: https://doi.org/10.1007/s10620-017-4652-5

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