P2668 - Histologic Serrated Epithelial Change and Superficial Hyperplastic Change Is Associated With Increased Risk of Dysplasia in Patients With Inflammatory Bowel Disease

Hasan Saleh, MD, MBA, Jami A. Kinnucan, MD, FACG, Jana G. Hashash, MD, MSc, Michael F. Picco, PhD, MD, Francis A. Farraye, MD, MSc, Tarek Odah, MD
Mayo Clinic, Jacksonville, FL

Introduction: The significance of serrated epithelial change (SEC) and superficial hyperplastic change (SHC) in patients with inflammatory bowel disease (IBD) is not well understood. We aim to investigate the association between SEC/SHC and the development of concurrent or future dysplasia or colorectal cancer (CRC) in patients with IBD.

Methods: This multicenter retrospective study included adult patients with IBD who underwent surveillance colonoscopy between January 2000 and September 2023 and had evidence of SEC/SHC with a history of IBD-associated colitis seen on histology. Data was collected on demographics and medical/endoscopic history. The first colonoscopy to note SEC/SHC was defined as the index colonoscopy. Follow-up colonoscopy data included follow-up time, number of endoscopies, and findings of colonic dysplasia or CRC. Statistical analysis utilized Fisher’s exact test and Mann-Whitney U test.

Results: Thirty-seven patients with IBD had findings of SEC/SHC, with the majority having ulcerative colitis (UC) and a median disease duration of 19.5 years (IQR 8.1-30.6). On the index exam, 12 (32%) patients had concurrent dysplasia, while 25 (68%) had no dysplasia. The median follow-up time was 26.5 months (IQR 16.1-52.2). Among the 25 patients without dysplasia on index colonoscopy, 21 (84%) remained dysplasia-free (median follow-up 33.1 months, IQR 4.7-53.7) including 6 (24%) without follow-up, and 4 (16%) developed dysplasia (median follow up 13.9 months, IQR 6.1-31.1). Among the 12 patients with both dysplasia and SEC/SHC on the index exam, 3 (25%) developed CRC during the follow-up period. Table 1 compares patients with dysplasia/CRC and those who remained dysplasia-free. A history of dysplasia prior to the SEC/SHC index exam was predictive of future dysplasia (56.3% vs 9.5%, p=0.01). SEC/SHC was visible in 24.3% of patients and multifocal in 27% of them. Chromoendoscopy was used in 10/37 (27%) patients on index exam. Overall, 10 out of 16 (63%) patients had dysplasia or CRC in the same colonic segment as SEC/SHC.

Discussion: Histologic findings of SEC/SHC are associated with the detection of synchronous and metachronous dysplasia or CRC in up to 43% of patients with IBD. This risk is greater than that of the general IBD population, with new dysplasia detected after 14 months. Patients with IBD and SEC/SHC warrant closer surveillance, enhanced endoscopic imaging techniques and shared decision-making conversations about their risk of future dysplasia and CRC.


Disclosures:


Hasan Saleh, MD, MBA, Jami A. Kinnucan, MD, FACG, Jana G. Hashash, MD, MSc, Michael F. Picco, PhD, MD, Francis A. Farraye, MD, MSc, Tarek Odah, MD. P2668 - Histologic Serrated Epithelial Change and Superficial Hyperplastic Change Is Associated With Increased Risk of Dysplasia in Patients With Inflammatory Bowel Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.