Low Incidence of Dysplasia and Colorectal Cancer Observed among Inflammatory Bowel Disease Patients with Prolonged Colonic Diversion

Weston Bettner, Anthony Rizzo, Steven Brant, Sharon Dudley-Brown, Jonathan Efron, Sandy H Fang, Susan L Gearhart, Michael Marohn, Alyssa Parian, Maryam Kherad Pezhouh, Joanna Melia, Bashar Safar, Brindusa Truta, Elizabeth Wick, Mark Lazarev

Research output: Contribution to journalArticle

Abstract

Background In inflammatory bowel disease (IBD), many scenarios call for fecal diversion, leaving behind defunctionalized bowel. The theoretical risk of colorectal cancer (CRC) in this segment is frequently cited as a reason for resection. To date, no studies have characterized the incidence of neoplasia in the diverted colorectal segments of IBD patients. Methods A retrospective cohort analysis was conducted for IBD patients identified through a tertiary care center pathology database. Patients that had undergone colorectal diversion and were diverted for ≥ 1 year were included. Incidence of diverted dysplasia/CRC was calculated for Crohn's disease (CD) and ulcerative colitis (UC) with respect to diverted patient-years (dpy) and patient-years of disease (pyd). Results In total, 154 patients comprising 754 dpy and 1984 pyd were analyzed. Only 2 cases of diverted colorectal dysplasia (CD 1, UC 1) and 1 case of diverted CRC (UC) were observed. In the UC cohort (n = 75), the rate of diversion-associated CRC was 4.5 cases/1000 dpy (95% CI 0.11-25/1000) or 1.5 cases/1000 pyd (95% CI 0.04-8.2/1000). In the CD cohort (n = 79), no patients developed CRC, although a dysplasia rate of 1.9 cases/1000 dpy (95% CI 0.05-11/1000) or 0.77 cases/1000 pyd (95% CI 0.02-4.3/1000) was observed. All patients developing neoplasia had disease duration > 10 years and microscopic inflammation. Conclusions Diverted dysplasia occurred infrequently with rates overlapping those reported in registries for IBD-based rectal cancers. Neoplasia was undetected in patients with < 10 pyd, regardless of diversion duration, suggesting low yield for endoscopic surveillance before this time.

Original languageEnglish (US)
Pages (from-to)1092-1098
Number of pages7
JournalInflammatory Bowel Diseases
Volume24
Issue number5
DOIs
Publication statusPublished - Apr 23 2018

    Fingerprint

Keywords

  • colorectal cancer (CRC)
  • Crohn's disease (CD)
  • diversion
  • dysplasia
  • inflammatory bowel disease (IBD)
  • ulcerative colitis (UC)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this