Issue 01

Clinical Question

Are patients with pseudopolyps more likely to develop colorectal cancer?

Editor’s Bottom Line

Inflammatory pseudopolyps were not associated with an increased risk of colorectal neoplasia. This may have consequences for surveillance strategies and intervals.

Reference

Mahmoud R, Shah SC, ten Hove JR, et al. No Association Between Pseudopolyps and Colorectal Neoplasia in Patients With Inflammatory Bowel Diseases. Gastroenterol. Epub online Dec 7, 2018; https://www.gastrojournal.org/article/S0016-5085(18)35386-1/pdf.

Synopsis

It is unclear whether inflammatory pseudopolyps, present in as many as 45% of patients with colonic IBD, convey a higher risk of developing colorectal cancer (CRC) or high-grade dysplasia (HGD). In this retrospective cohort study, researchers at Mount Sinai Hospital in New York and at Utrecht University Medical Center in The Netherlands examined electronic health record data from 1,582 IBD patients. The patients had undergone surveillance colonoscopies for CRC or HGD between January 1997 and January 2017 for a median follow-up of 4.8 years. Eligible subjects had IBD for eight years or longer, apart from those with primary sclerosing cholangitis, who were included in the analysis regardless of disease duration. All individuals had colonic disease involvement and none had a history of CRC, HGD or colectomy.

The findings showed 29% (n=462) of patients had pseudopolyps. These individuals were significantly more likely than patients without pseudopolyps to have more severe inflammation (adjusted odds ratio [aOR]: 1.32; 95% Confidence interval [CI], 1.13–1.55) and more extensive disease (aOR: 1.92; 95% CI, 1.34–2.74), and they were less likely to have primary sclerosing cholangitis (aOR: 0.38; 95% CI, 0.26–0.55).

Results also revealed that 3.7% and 2.0% of patients with or without pseudopolyps, respectively, developed CRC or HGD during the study period. This difference was not statistically significant (P=0.41). Multiple regression analysis confirmed pseudopolyps were not independently associated with an increased risk of CRC or HGD (adjusted hazard ratio: 1.17; 95% CI, 0.59–2.31). Among those who developed CRC or HGD, the time until development of neoplasia did not differ significantly between those with or without pseudopolyps (3.8 years vs. 4.2 years, respectively).

Details

Study Design: Retrospective cohort
Funding: Not reported
Allocation: Not applicable
Setting: Multi-center
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.