Mount Sinai Researchers: 20-Year Study Reveals Pseudopolyps Do Not Predict Neoplasia in IBD patients
Study fills gap in literature that addresses the risk of colorectal neoplasia and colectomy in patients with IBD and pseudopolyps
In a study published today in Gastroenterology, a team of researchers from the Icahn School of Medicine at Mount Sinai and elsewhere finds that there is no association between post-inflammatory polyps (PIPs), also known as pseudopolyps, and advanced colorectal neoplasia (CRN) in patients with inflammatory bowel disease (IBD).
The result could affect how IBD patients undergo screening colonoscopies. In Europe, guidelines propose that patients with PIPs receive more frequent surveillance colonoscopies, despite limited evidence of increased risk. The study results suggest that may be unwarranted.
Patients with longstanding inflammatory bowel disease (IBD) colitis are at increased risk of developing colorectal dysplasia and colorectal cancer (CRC). CRC is one of the leading causes of mortality worldwide. PIPs are encountered in 20-35 percent of patients with IBD and colonic involvement. Whether they are accurate predictors of colorectal neoplasia has long remained a question. Colorectal neoplasia is a new abnormal growth, or mass, of cells, which can be benign or malignant; doctors monitor neoplasia carefully as it can be an early sign of cancer.
The team of researchers from the United States and the Netherlands conducted a multicenter study involving 1,582 eligible patients, 462 (29 percent) of whom had PIPs, at five academic hospitals and two large non-academic hospitals in the two countries. Surveillance of patients took place from January 1997 through January 2017.
The purpose of the 20-year study was to define the risk of CRN and colectomy in patients with IBD and PIPs. No previous study had addressed whether PIPs are a reliable predictor of advanced CRN.
The researchers found that PIPs were associated with more severe inflammation, greater disease extent, and lower likelihood of primary sclerosing cholangitis, a rare and chronic disease of the liver and bile duct, but were not, in themselves, independent predictors of advanced CRN.
During a median follow-up of 4.8 years, the time until development of advanced CRN did not differ significantly between patients with PIPs and those without. PIPs did not independently increase the risk of advanced CRN (adjusted hazard ratio, 1.17; 95 percent CI, 0.59-2.31). The colectomy rate was significantly higher in patients with PIPs (P=0.01), possibly because colectomies were being done for medically refractory disease (ongoing inflammation, not neoplasia). More colectomies were done in the Netherlands than at Mount Sinai, likely reflecting different practice patterns.
“This is very good news for the IBD patient with pseudopolyps, as their surveillance colonoscopies will likely be affected by these results. We hope that doctors treating these IBD patients would be less fearful of colon cancer risk in a colon with PIPs, and forego shortened intervals of surveillance as a result of our findings, lending to improved quality of life and lower healthcare costs,” says corresponding author Steven Itzkowitz, MD, Professor of Medicine and Oncological Sciences, and Director of the GI Fellowship Program at the Icahn School of Medicine at Mount Sinai.
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