P4312 - Older Adults With Inflammatory Bowel Disease Are at Increased Risk of Dysplasia Progression

Kate E. Lee, MD, MS¹, Anivarya Kumar, BA², Grace Kim, BS², Madhura Pande, BS², Jacqueline M. Emerson, BS², Maxwell D. Sumner, BS², Oliver A. Stewart, MD¹, Alessandro Racioppi, MS², Alice A. Agyekum, BS³, Olivia R. Delau, MS⁴, Aasma Shaukat, MD, MPH⁵, Jordan Axelrad, MD, MPH⁶, Chin Hur, MD, MPH³, Bo Shen, MD⁷, Jane E. Onken, MD, MHS¹, Adam S.. Faye, MD^6
1Duke University Medical Center, Durham, NC; ²Duke University School of Medicine, Durham, NC; ³Columbia University Irving Medical Center, New York, NY; ⁴NYU Langone Health Inflammatory Bowel Disease Center, Cortlandt Manor, NY; ⁵NYU Langone Health, New York, NY; ⁶NYU Grossman School of Medicine, New York, NY; ⁷Columbia University, New York, NY

Introduction: Although inflammatory bowel disease (IBD) increases the risk of colorectal cancer (CRC), data detailing which factors increase this risk, as well as the risk of dysplasia progression, are scant in the current biologic-era.

Methods: In a retrospective single-center analysis, we identified 389 patients with ulcerative colitis (UC) or Crohn’s disease (CD) who had at least two colonoscopies between 2008-2024, capturing a colonoscopy for dysplasia surveillance within 5-14 years of IBD diagnosis (“index colonoscopy”) and at least one subsequent colonoscopy. Exclusion criteria included those with primary sclerosing cholangitis, exclusively ileal CD, prior CRC, or a total colectomy prior to index colonoscopy. Univariable analysis assessed risk factors for dysplasia at index colonoscopy (limited N), whereas adjusted Cox proportional hazards models were used to assess dysplasia progression.

Results: Overall, the median age was 40 years (IQR 29-53 years) with 56.6% female and 52.2% having UC. In total, 24 individuals (6.2%) had low grade dysplasia (LGD) at index colonoscopy, whereas none had high grade dysplasia (HGD)/CRC. On univariable analysis, patients who had dysplasia at index colonoscopy were significantly more likely to be older (58 vs 39 years, p< 0.01), and have had a prior non-CRC related malignancy (p = 0.01). When evaluating dysplasia progression among 389 patients with a median follow-up of 4.1 years (IQR 2.7-6.4) from index colonoscopy, 45 patients initially negative for dysplasia developed LGD (42), HGD (2), or CRC (1) (Figure 1). Further, older age (_adjHR 1.04, 95%CI 1.02-1.06) was associated with increased risk of dysplasia progression, even when adjusting for number of colonoscopies (Table 1). On sensitivity analysis, we found similar results when: 1) only including patients with a screening colonoscopy within 8-10 years of IBD diagnosis, 2) ensuring dysplasia was only in areas of remission, and 3) ensuring dysplasia was only in areas of prior known disease activity (to distinguish probable IBD-related dysplasia from sporadic adenoma).

Discussion: Although dysplasia progression was common, HGD and/or CRC were uncommon. Further, we found that older age was associated with the presence of dysplasia at initial surveillance colonoscopy, as well as an independent risk factor for dysplasia progression. Our findings suggest that screening strategies for dysplasia in IBD may need to account for chronological age, though larger-scale studies are needed to confirm this.



Disclosures:


Kate E. Lee, MD, MS¹, Anivarya Kumar, BA², Grace Kim, BS², Madhura Pande, BS², Jacqueline M. Emerson, BS², Maxwell D. Sumner, BS², Oliver A. Stewart, MD¹, Alessandro Racioppi, MS², Alice A. Agyekum, BS³, Olivia R. Delau, MS⁴, Aasma Shaukat, MD, MPH⁵, Jordan Axelrad, MD, MPH⁶, Chin Hur, MD, MPH³, Bo Shen, MD⁷, Jane E. Onken, MD, MHS¹, Adam S.. Faye, MD⁶. P4312 - Older Adults With Inflammatory Bowel Disease Are at Increased Risk of Dysplasia Progression, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.