The Fate of Unifocal Versus Multifocal Low-Grade Dysplasia at the Time of Colonoscopy in Patients With IBD.

Background Recommendations regarding management of colorectal dysplasia in the setting of IBD continue to evolve. Objective This study aimed to determine the rate of progression from dysplasia to adenocarcinoma, specifically focusing on the differences in unifocal and multifocal low-grade dysplasia and dysplasia found on random biopsy versus targeted biopsies. Design This is a retrospective review. Setting This study was conducted at an IBD referral center. Patients All adult patients (≥18 years of age) with a known diagnosis of either ulcerative colitis or Crohn's disease, who underwent a surveillance colonoscopy between January 1, 2010 and January 1, 2019, were selected. Main outcomes measures The primary outcomes measured were the progression of dysplasia and the risk factors for progression. Results A total of 23,751 surveillance colonoscopies were performed among 12,289 patients between January 1, 2010 and January 1, 2019. The mean age at colonoscopy was 52.1 years (SD 16.9 years), 307 patients (2.5%) had a history of primary sclerosing cholangitis, and 3887 (3.15%) had a family history of colorectal cancer. There was a total of 668 patients (5.4%) with low-grade dysplasia, 76 patients (0.62%) with high-grade dysplasia, and 68 patients (0.55%) with adenocarcinoma in the series. The 1-, 2-, and 5-year cumulative incidence rate of progressing from low-grade dysplasia to high-grade dysplasia were 1.6%, 4.8%, and 7.8%. The 1- and 2-year cumulative incidence rates of progressing from low-grade dysplasia to adenocarcinoma were 0.7% and 1.6%. There were no significant differences in unifocal and multifocal progression. Primary sclerosing cholangitis, ulcerative colitis, male sex, and advanced age were all found to be significant risk factors for neoplasia on multivariable analysis. Limitations A retrospective database was a source of information. Conclusion Progression of low-grade dysplasia to adenocarcinoma, regardless of its being unifocal or multifocal, remains very low in the setting of adequate surveillance and medical management. The presence of multifocal low-grade dysplasia should not change the decision making to pursue ongoing endoscopic surveillance versus proctocolectomy. Patients who had primary sclerosing cholangitis with dysplasia found on random biopsies may be at highest risk for dysplasia progression. See Video Abstract at http://links.lww.com/DCR/A649. El desenlace de la displasia de bajo grado unifocal versus multifocal durante la colonoscopia en pacientes con enfermedad inflamatoria intestinal ANTECEDENTES:Las recomendaciones para el tratamiento de la displasia colorrectal en el contexto de la enfermedad inflamatoria intestinal siguen evolucionando.OBJETIVO:Determinar la tasa de progresion de displasia a adenocarcinoma, centrandose especificamente en las diferencias en displasia de bajo grado unifocal y multifocal, y displasia encontradas en biopsias aleatorias versus biopsias dirigidas.DISENO:Revision retrospectiva.AMBITO:Centro de referencia de EII.PACIENTES:Todos los pacientes adultos (> 18 anos) con un diagnostico comprobado de colitis ulcerosa o enfermedad de Crohn que se sometieron a una colonoscopia de vigilancia entre el 1 de enero de 2010 y el 1 de enero de 2019.PRINCIPALES VARIABLES ANALIZADAS:Progresion de la displasia y factores de riesgo de progresion.RESULTADOS:Se realizaron un total de 23.751 colonoscopias de vigilancia en 12.289 pacientes entre el 1/1/2010 y el 1/1/2019. La edad media en el momento de la colonoscopia fue de 52,1 anos (DE 16,9 anos), 307 pacientes (2,5%) tenian antecedentes de colangitis esclerosante primaria y 3887 (3,15%) tenian antecedentes familiares de cancer colorrectal. Hubo un total de 668 pacientes (5,4%) con displasia de bajo grado, 76 pacientes (0,62%) con displasia de alto grado y 68 pacientes (0,55%) con adenocarcinoma en la serie. La tasa de incidencia acumulada de 1, 2, 5 anos de progresion de displasia de bajo grado a displasia de alto grado fue del 1,6%, 4,8% y 7,8%. Las tasas de incidencia acumulada de 1 y 2 anos de progresion de displasia de bajo grado a adenocarcinoma fueron 0,7% y 1,6%, respectivamente. No hubo diferencias significativas en la progresion unifocal y multifocal. Se encontro que la colangitis esclerosante primaria, la colitis ulcerosa, el sexo masculino y la edad avanzada eran factores de riesgo significativos de neoplasia en el analisis multivariable.LIMITACIONES:Base de datos retrospectiva.CONCLUSION:La progresion de la displasia de bajo grado a adenocarcinoma, independientemente de que sea unifocal o multifocal, sigue siendo muy baja en el contexto de una vigilancia y un tratamiento medico adecuados. La presencia de displasia multifocal de bajo grado no deberia cambiar la toma de decision para continuar con vigilancia endoscopica continua o realizar la proctocolectomia. Los pacientes con colangitis esclerosante primaria y displasia encontrada en biopsias aleatorias pueden tener una mayor progresion de la displasia. Consulte Video Resumen en http://links.lww.com/DCR/A649.