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P289. Colon cancer and colonic dysplasia in ulcerative colitis and Crohn's colitis: a single center cohort study

E. Lolli1, G. Palmieri1, G. Condino1, E. Calabrese1, C. Petruzziello1, S. Onali1, F. Pallone1, L. Biancone1, 1Università Tor Vergata, Roma, Roma, Italy

Background

The risk of colon cancer and the frequency of colonic dysplasia in Ulcerative Colitis (UC) and colonic Crohn's Disease (CD) is under debate, due to recent discrepant findings. In a retrospective cohort study, we assessed the frequency of colon cancer (CC) in patients (pts) with UC and CD colitis in follow up from 2000 to 2010 at our tertiary IBD center. In a subgroup analysis, the rate of detection of colonic dysplasia in biopsies taken from the same cohort of IBD pts with no CC was re-evaluated by an experienced histopathologist.

Methods

All colonic biopsies taken during routine colonoscopy performed by the same gastroenterologist from 2006 to 2010 in pts with UC or CD colitis under follow up were reviewed. Two biopsies were taken from each colonic area, according to current guidelines, including the involved areas and suspect lesions. Samples were stained for routine histology. Dysplasia was defined according to the ECCO guidelines. Data were expressed as median and range.

Results

The first cohort of IBD pts included 607 UC (375 M, age 44, range 18–90; UC duration 7yrs, range 1–47) and 199 CD pts with colitis (C) or ileo-colitis (I-C) (96 M, age 46, range 20–83; CD duration 7, range 1–47). The frequency of CC was 2/607 (0.3%) in UC, 1/199 (0.5%) in CD. Cancer involved the sigmoid colon (2), right colon (1) in UC (age 30, 44, 57yrs; UC duration 1.6 and 20yrs, respectively; no anti-TNFs or immunomodulators, IMM) and the sigmoid colon in 1 I-C CD (36yrs, CD duration: 24yrs, long term IMM and anti-TNFs). Biopsies performed during 338 colonoscopies in IBD pts performing ≥1 colonoscopy, including 260 UC (age 38, range 22–89; UC duration 8yrs, range 1–44; 4 ileo-rectal anastomosis, 153 distal, 39 left, 63 extensive; IMM 61, anti-TNFs 24, anti-TNF+IMM 22) and 78 CD colitis (n = 36) or ileo-colitis (n = 52) (age 40, range 22–77; CD duration 9yrs, range 1–30; IMM 33, anti-TNFs 28, IMM+anti-TNFs 22). Endoscopy included complete colonoscopy (n = 225), sigmoidoscopy (n = 81) or incomplete colonoscopy in 32 (9.5%). Two biopsies were taken from 683 colonic areas sampled during 338 colonoscopies. In none of the biopsy samples a re-evaluation detected dysplasia. This finding was concordant with the first evaluation.

Conclusion

In a cohort of patients with colonic IBD under follow up, a low rate of colon cancer and no dysplasia was observed. These findings further support that the risk of dysplasia in IBD colitis needs to be reassessed for proper timing of surveillance colonoscopy.