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
StatePublished - Apr 23 2018

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Inflammatory Bowel Diseases
Colorectal Neoplasms
Incidence
Ulcerative Colitis
Crohn Disease
Neoplasms
Rectal Neoplasms
Tertiary Care Centers
Registries
Cohort Studies

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

@article{00f4fa726c504a7483215ea0497498fc,
title = "Low Incidence of Dysplasia and Colorectal Cancer Observed among Inflammatory Bowel Disease Patients with Prolonged Colonic Diversion",
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.",
keywords = "colorectal cancer (CRC), Crohn's disease (CD), diversion, dysplasia, inflammatory bowel disease (IBD), ulcerative colitis (UC)",
author = "Weston Bettner and Anthony Rizzo and Steven Brant and Sharon Dudley-Brown and Jonathan Efron and Fang, {Sandy H} and Gearhart, {Susan L} and Michael Marohn and Alyssa Parian and {Kherad Pezhouh}, Maryam and Joanna Melia and Bashar Safar and Brindusa Truta and Elizabeth Wick and Mark Lazarev",
year = "2018",
month = "4",
day = "23",
doi = "10.1093/ibd/izx102",
language = "English (US)",
volume = "24",
pages = "1092--1098",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "John Wiley and Sons Inc.",
number = "5",

}

TY - JOUR

T1 - Low Incidence of Dysplasia and Colorectal Cancer Observed among Inflammatory Bowel Disease Patients with Prolonged Colonic Diversion

AU - Bettner, Weston

AU - Rizzo, Anthony

AU - Brant, Steven

AU - Dudley-Brown, Sharon

AU - Efron, Jonathan

AU - Fang, Sandy H

AU - Gearhart, Susan L

AU - Marohn, Michael

AU - Parian, Alyssa

AU - Kherad Pezhouh, Maryam

AU - Melia, Joanna

AU - Safar, Bashar

AU - Truta, Brindusa

AU - Wick, Elizabeth

AU - Lazarev, Mark

PY - 2018/4/23

Y1 - 2018/4/23

N2 - 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.

AB - 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.

KW - colorectal cancer (CRC)

KW - Crohn's disease (CD)

KW - diversion

KW - dysplasia

KW - inflammatory bowel disease (IBD)

KW - ulcerative colitis (UC)

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U2 - 10.1093/ibd/izx102

DO - 10.1093/ibd/izx102

M3 - Article

C2 - 29688465

AN - SCOPUS:85046292250

VL - 24

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JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

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