Open AccessOutcome after surveillance of low‐grade and indefinite dysplasia in patients with ulcerative colitis
Author(s) -
Pekow Joel R.,
Hetzel Jeremy T.,
Rothe Jami A.,
Hanauer Stephen B.,
Turner Jerrold R.,
Hart John,
Noffsinger Amy,
Huo Dezheng,
Rubin David T.
Publication year - 2010
Publication title -
inflammatory bowel diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.932
H-Index - 146
eISSN - 1536-4844
pISSN - 1078-0998
DOI - 10.1002/ibd.21184
Subject(s) - medicine , ulcerative colitis , dysplasia , primary sclerosing cholangitis , incidence (geometry) , gastroenterology , colectomy , medical record , hazard ratio , confidence interval , disease , physics , optics
Background: The management of low‐grade (LGD) and indefinite dysplasia (IND) in patients with ulcerative colitis (UC) remains controversial, as outcomes after a diagnosis of LGD or IND in previous studies vary widely. Methods: All patients evaluated were from a single institution referral center who had a history of UC and a diagnosis of either LGD or IND between 1994 and 2008 as confirmed by 2 expert gastrointestinal (GI) pathologists. Data were collected by chart review of electronic and paper medical records. All patients who did not undergo a colectomy within 90 days of their dysplasia diagnosis were included in the final analysis. Hazard ratios for risk factors as well as incidence rates and Kaplan–Meier estimates were used to calculate the progression to high‐grade dysplasia (HGD) or colorectal cancer (CRC). Results: Thirty‐five patients were included in the analysis, of whom 2 patients with IND and 2 patients with LGD developed HGD or CRC over a mean duration of 49.8 months. In total, the incident rate for advanced neoplasia for all patients was 2.7 cases of HGD or CRC per 100 person‐years at risk. For flat and polypoid LGD the incident rate of advanced neoplasia was 4.3 and 1.5 cases per 100 person‐years at risk, respectively. Patients with primary sclerosing cholangitis (PSC) had an incident rate of 10.5 cases per 100 years of patient follow‐up. Conclusions: We report a low rate of progression to HGD or CRC in patients who underwent surveillance for LGD or IND; polypoid dysplasia showed less risk of progression than flat dysplasia. (Inflamm Bowel Dis 2010)