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Journal of Gastrointestinal Surgery

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01-03-2012 | Original Article

Clinical Significance of Indefinite for Dysplasia on Pouch Biopsy in Patients with Underlying Inflammatory Bowel Disease

Authors: Zhao-Xiu Liu, Xiu-Li Liu, Deepa T. Patil, Lei Lian, Ravi P. Kiran, Feza H. Remzi, Run-Zhou Ni, Bo Shen

Published in: Journal of Gastrointestinal Surgery | Issue 3/2012

Abstract

Background

“Indefinite for dysplasia” (IND) on pouch mucosal biopsy is occasionally reported during routine histopathological evaluation. The natural history and implication of this histologic entity in ileal pouch-anal anastomosis (IPAA) has not been studied.

Aim

The aim of this study is to characterize cumulative probability, natural history, and clinical outcome of pouch IND in a cohort of patients with inflammatory bowel disease (IBD).

Methods

All 932 patients with restorative proctocolectomy and IPAA for IBD were included. Patients with or without IND were classified into the study and control groups. Demographic, clinical, endoscopic, and histologic variables were analyzed.

Results

The mean duration from IBD diagnosis to colectomy and from pouch construction to data entry was 8.4 ± 8.5 and 9.7 ± 6.2 years, respectively. A total of 2,250 surveillance or diagnostic pouchoscopies with biopsies were performed for the cohort. Twenty-one patients (2.3%) were diagnosed with anal transitional zone and/or pouch IND, for whom subsequent pouchoscopies were performed with the mean procedure number being 3.4 ± 2.2 per patient during a mean of follow-up of 19.3 ± 16.1 months. One patient with IND developed low-grade dysplasia and one had high-grade dysplasia in a separate endoscopy. Cox model showed the presence of primary sclerosing cholangitis was an independent risk factor for pouch IND [hazard ratio = 6.76 (95% CI 2.56–17.88)]. Interobserver agreement (kappa score) for diagnosing pouch IND between GI pathologists ranged from 0.67 to 0.76.

Conclusions

Subsequent dysplasia was uncommon in pouch patients with IND. Natural history of pouch IND warrants further long-term investigation.

Kariv R, Remzi FH, Lian L, et al. Preoperative colorectal neoplasia increases risk for pouch neoplasia in patients with restorative proctocolectomy. Gastroenterology 2010;139:806-12. PubMedCrossRef

Scarpa M, van Koperen PJ, Ubbink DT, Hommes DW, Ten Kate FJ, Bemelman WA. Systematic review of dysplasia after restorative proctocolectomy for ulcerative colitis. Br J Surg. 2007;94:534-45.PubMedCrossRef

Ståhlberg D, Veress B, Tribukait B, et al. Atrophy and neoplastic transformation of the ileal pouch mucosa in patients with ulcerative colitis and primary sclerosing cholangitis: a case control study. Dis Colon Rectum 2003;46:770-8.PubMedCrossRef

Veress B, Reinholt FP, Lindquist K, et al. Different types of mucosal adaptation in the ileal reservoir after restorative proctocolectomy. A two-year follow-up study. APMIS 1990;98:786-96.PubMedCrossRef

Sonwalkar SA, Rotimi O, Scott N, et al. A study of indefinite for dysplasia in Barrett’s oesophagus: reproducibility of diagnosis, clinical outcomes and predicting progression with AMACR (alpha-methylacyl-CoA-racemase). Histopathology 2010;56:900-7.PubMedCrossRef

Tava F, Luinetti O, Ghigna MR, et al. Type or extension of intestinal metaplasia andimmature/atypical “indefinite-for-dysplasia” lesions as predictors of gastric neoplasia. Hum Pathol 2006;37:1489-97.PubMedCrossRef

Pekow JR, Hetzel JT, Rothe JA, et al. Outcome after surveillance of low-grade and indefinite dysplasia in patients with ulcerative colitis. Inflamm Bowel Dis 2010;16:1352-6.PubMed

Ullman T, Croog V, Harpaz N, et al. Progression to colorectal neoplasia in ulcerative colitis: effect of mesalamine. Clin Gastroenterol Hepatol 2008;6:1225-30.PubMedCrossRef

Shen B, Achkar JP, Connor JT, et al. Modified pouchitis disease activity index: a simplified approach to the diagnosis of pouchitis. Dis Colon Rectum 2003;46:748-53.PubMedCrossRef

10.

Wu H, Shen B. Pouchitis and pouch dysfunction. Gastroenterol Clin North Am 2009;38:651-68.PubMedCrossRef

11.

Shen B, Fazio VW, Remzi FH, et al. Clinical features and quality of life in patients with different phenotypes of Crohn’s disease of the pouch. Dis Colon Rectum 2007;50:1450-9.PubMedCrossRef

12.

Shen B, Fazio VW, Remzi FH, et al. Risk factors for clinical phenotypes of Crohn’s disease of the pouch. Am J Gastroenterol 2006;101:2760-8.PubMedCrossRef

13.

Shen B, Remzi FH, Lavery IC, et al. A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy for ulcerative colitis. Clin Gastroenterol Hepatol 2008;6:145-58.PubMedCrossRef

14.

Shen B, Fazio VW, Remzi FH, et al. Risk factors for diseases of ileal pouch-anal anastomosis in patients with ulcerative colitis. Clin Gastroenterol Hepatol 2006;4:81–9.PubMedCrossRef

15.

Shen B, Remzi FH, Lavery IC, Lashner BA, Fazio VW. A proposed classification of ileal pouch disorders and associated complications after restorative proctocolectomy. Clin Gastroenterol Hepatol 2008;6:145-58.PubMedCrossRef

16.

Riddell RH, Goldman H, Ransohoff DF, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol 1983;14:931-68.PubMedCrossRef

17.

Sandborn WJ, Tremaine WJ, Batts KP, et al. Pouchitis after ileal pouch-anal anastomosis: A pouchitis disease activity index. Mayo Clin Proc 1994;69:409–15.PubMed

18.

Heuschen UA, Autschbach F, Allemeyer EH, et al. Long-term follow-up after ileoanal pouch procedure. Algorithm for diagnosis, classification, and management of pouchitis. Dis Colon Rectum 2001;44:487-99.PubMedCrossRef

19.

Shen B, Plesec TP, Kariv R, et al. Evaluation of tissue eosinophilia the pouch and afferent limb in patients restorative proctocolectomy. Inflamm Bowel Dis 2008;14:744–9.PubMedCrossRef

20.

Ullman T, Odze R, Farraye FA. Diagnosis and management of dysplasia in patients with ulcerative colitis and Crohn’s disease of the colon. Inflamm Bowel Dis 2009;15:630-8.PubMedCrossRef

21.

Harpaz N, Polydorides AD. Colorectal dysplasia in chronic inflammatory bowel disease: pathology, clinical implications, and pathogenesis. Arch Pathol Lab Med 2010;134:876-95.PubMed

22.

Montgomery E, Goldblum JR, Greenson JK, et al. Dysplasia as a predictive marker for invasive carcinoma in Barrett esophagus: a follow-up study based on 138 cases from a diagnostic variability study. Hum Pathol 2001;32:379–88. PubMedCrossRef

23.

Rutter MD, Saunders BP, Wilkinson KH, et al. Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology. 2006;130:1030–8.PubMedCrossRef

24.

van Schaik FD, Ten Kate FJ, Offerhaus GJ, et al. Misclassification of dysplasia in patients with inflammatory bowel disease: consequences for progression rates to advanced neoplasia. Inflamm Bowel Dis 2010 Sep 7. [Epub ahead of print]

25.

Das P, Smith JJ, Lyons AP, Tekkis PP, Clark SK, Nicholls RJ. Assessment of the mucosa of the indefinitely diverted ileo-anal pouch. Colorectal Dis 2008;10:512–7.PubMedCrossRef

26.

Nilubol N, Scherl E, Bub DS, et al. Mucosal dysplasia in ileal pelvic pouches after restorative proctocolectomy. Dis Colon Rectum 2007;50:825-31.PubMedCrossRef

27.

Thompson-Fawcett MW, Rust NA, Warren BF, et al. Aneuploidy and columnar cuff surveillance after stapled ileal pouch-anal anastomosis in ulcerative colitis. Dis Colon Rectum 2000;43:408-13.PubMedCrossRef

28.

Thackeray EW, Charatcharoenwitthaya P, Elfaki D, Sinakos E, Lindor KD. Colon neoplasms develop early in the course of inflammatory bowel disease and primary sclerosing cholangitis. Clin Gastroenterol Hepatol 2011;9:52-6PubMedCrossRef

29.

Penna C, Dozois R, Tremaine W, et al. Pouchitis after ileal pouch-anal anastomosis for ulcerative colitis occurs with increased frequency in patients with associated primary sclerosing cholangitis. Gut 1996;38:234–9.PubMedCrossRef

30.

Marchesa P, Lashner BA, Lavery IC, et al. The risk of cancer and dysplasia among ulcerative colitis patients with primary sclerosing cholangitis. Am J Gastroenterol 1997;92:1285-8.PubMed

31.

Vieth M, Grunewald M, Niemeyer C, et al. Adenocarcinoma in an ileal pouch after prior proctocolectomy for carcinoma in a patient with ulcerative pancolitis. Virchows Arch. 1998;433:281–4. PubMedCrossRef

32.

Hassan C, Zullo A, Speziale G, et al. Adenocarcinoma of the ileoanal pouch anastomosis: an emerging complication? Int J Colorectal Dis 2003;18:276–8.PubMed

33.

Eaden J, Abrams K, McKay H, et al. Inter-observer variation between general and specialist gastrointestinal pathologists when grading dysplasia in ulcerative colitis. J Pathol 2001;194:152-7. PubMedCrossRef

34.

Odze RD, Goldblum J, Noffsinger A, et al. Interobserver variability in the diagnosis of ulcerative colitis-associated dysplasia by telepathology. Mod Pathol 2002;15:379-86.PubMedCrossRef

35.

Hultén L, Willén R, Nilsson O, et al. Mucosal assessment for dysplasia and cancer in the ileal pouch mucosa in patients operated on for ulcerative colitis—A 30-year follow-up study. Dis Colon Rectum 2002;45:448-52.PubMedCrossRef

36.

Börjesson L, Willén R, Haboubi N, Duff SE, Hultén L. The risk of dysplasia and cancer in the ileal pouch mucosa after restorative proctocolectomy for ulcerative proctocolitis is low: a long-term follow-up study. Colorectal Dis 2004;6:494–8.PubMedCrossRef

Title: Clinical Significance of Indefinite for Dysplasia on Pouch Biopsy in Patients with Underlying Inflammatory Bowel Disease
Authors: Zhao-Xiu Liu
Xiu-Li Liu
Deepa T. Patil
Lei Lian
Ravi P. Kiran
Feza H. Remzi
Run-Zhou Ni
Bo Shen
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 3/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-011-1779-0

2024 ASCO Annual Meeting

Springer Medicine

Clinical Significance of Indefinite for Dysplasia on Pouch Biopsy in Patients with Underlying Inflammatory Bowel Disease

Abstract

Background

Aim

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Aim

Methods

Results

Conclusions

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