P0830 - Rectal Cuff Inflammation on Initial Pouchoscopy is Associated with Neoplasia Development in IBD Patients With an Ileal Pouch-Anal Anastomosis: A Case-Control Study

Joseph Carter Powers, BA¹, Mark Zemanek, DO², Katherine Westbrook Cates, DO³, Emma F. Dester, MS¹, Mili Dave, BA⁴, Tracy Hull, MD⁵, Olga Lavryk, MD², Benjamin L. Cohen, MD², Edward Barnes, MD, MPH, FACG⁴, Taha Qazi, MD^6
1Cleveland Clinic Lerner College of Medicine, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Louisiana State University Health, Cleveland, OH; ⁴University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; ⁵Cleveland Clinic, Cleveland, OH; ⁶Cleveland Clinic Foundation, Beachwood, OH

Introduction: Patients with an ileal pouch-anal anastomosis (IPAA) are at risk for neoplasia of the pouch and rectal cuff. There are numerous purported risk factors for neoplasia including chronic cuff inflammation, but there is a lack of research assessing this potential relationship. The objective of this study was to assess if cuff inflammation identified during one’s initial pouchoscopy following surgery is associated with neoplasia development.

Methods: This two-institution case-control study included inflammatory bowel disease (IBD) patients with neoplasia of the rectal cuff or ileal pouch who were age- and sex-matched in a 1:4 ratio to controls without neoplasia. Neoplasia was defined as dysplasia (low/high grade) or cancer (adenocarcinoma). Cuff inflammation was defined as description of erythema, edema, and ulcerations, which was verified by a provider with expertise in inflammatory pouch diseases. A multivariable logistic regression was used to assess for association between initial cuff inflammation and neoplasia while adjusting for potential confounders.

Results: A total of 47 cases of neoplasia were identified and matched to 188 controls. Most patients had a diagnosis of ulcerative colitis (93.2%) with a small number having a diagnosis of Crohn’s disease or indeterminate colitis (3.4% each). Individuals in the case group had a longer interval between final surgery and first pouchoscopy compared to controls (median 2.2 vs. 1.1 years; p < 0.001) and were more likely to demonstrate cuff inflammation on initial pouchoscopy (51% vs. 33%, p = 0.024). Rectal cuff dysplasia was most common (Figure 1; n = 23), followed by pouch dysplasia, cuff cancer, pouch cancer, and neoplasia of both sites. The median time to neoplasia development was 21.6 (IQR 13.3-33.3) years after surgical completion with event times ranging from 0.4-43.4 years. On multivariable analysis, individuals with initial cuff inflammation had a nearly 3 times higher odds of neoplasia (Table 1; aOR = 2.91; 95% CI 1.29-6.57; p = 0.010) while adjusting for follow-up time, primary sclerosing cholangitis (PSC), and surgical indication of neoplasia. A surgical indication of neoplasia was also associated with a higher risk of neoplasia (aOR = 3.86; 95% CI 1.60-9.32; p = 0.003).

Discussion: Initial rectal cuff inflammation is associated with development of rectal cuff and ileal pouch neoplasia in IBD patients with an IPAA. This endoscopic finding should be included with other risk factors when evaluating a patient’s risk for neoplasia.



Disclosures:


Joseph Carter Powers, BA¹, Mark Zemanek, DO², Katherine Westbrook Cates, DO³, Emma F. Dester, MS¹, Mili Dave, BA⁴, Tracy Hull, MD⁵, Olga Lavryk, MD², Benjamin L. Cohen, MD², Edward Barnes, MD, MPH, FACG⁴, Taha Qazi, MD⁶. P0830 - Rectal Cuff Inflammation on Initial Pouchoscopy is Associated with Neoplasia Development in IBD Patients With an Ileal Pouch-Anal Anastomosis: A Case-Control Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.