Prior colorectal neoplasia is associated with increased risk of ileoanal pouch neoplasia in patients with inflammatory bowel disease.
OBJECTIVE
Although restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) substantially reduces the risk of colorectal cancer in patients with inflammatory bowel disease (IBD), subsequent pouch neoplasia can develop. There are few data on the incidence of and risk factors for neoplasia, so there is no consensus on the need for pouch surveillance. We aimed to determine the cumulative incidence of pouch neoplasia in patients with IBD and identify risk factors for developing pouch neoplasia.


METHODS
We searched the Dutch Pathology Registry (PALGA) to identify all patients with IBD and IPAA in The Netherlands from January 1991 to May 2012. We calculated the cumulative incidence of pouch neoplasia and performed a case-control study to identify risk factors. Demographic and clinical variables were analyzed with univariable and multivariable Cox regression analyses.


RESULTS
We identified 1200 patients with IBD and IPAA; 25 (1.83%) developed pouch neoplasia, including 16 adenocarcinomas. Respective cumulative incidences at 5, 10, 15, and 20 years were 1.0%, 2.0%, 3.7%, and 6.9% for pouch neoplasia and 0.6%, 1.4%, 2.1%, and 3.3% for pouch carcinoma. A history of colorectal neoplasia was the only risk factor associated with pouch neoplasia. Hazard ratios were 3.76 (95% confidence interval, 1.39-10.19) for prior dysplasia and 24.69 (95% confidence interval, 9.61-63.42) for prior carcinoma.


CONCLUSIONS
The incidence of pouch neoplasia in patients with IBD without a history of colorectal neoplasia is relatively low. Prior dysplasia or colon cancer is associated with an approximate 4- and 25-fold increase in risk, respectively, of developing pouch neoplasia.
Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Lauranne A A P
LA
Derikx
Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Wietske
W
Kievit
Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Joost P H
JP
Drenth
Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Dirk J
DJ
de Jong
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Cyriel Y
CY
Ponsioen
Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
Bas
B
Oldenburg
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
Andrea E
AE
van der Meulen-de Jong
Department of Gastroenterology and Hepatology, University Medical Center, Groningen, The Netherlands.
Gerard
G
Dijkstra
Department of Gastroenterology and Hepatology, St Elisabeth Hospital, Tilburg, The Netherlands.
Marina J A L
MJ
Grubben
Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Cornelis J H M
CJ
van Laarhoven
Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Iris D
ID
Nagtegaal
Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: f.hoentjen@mdl.umcn.nl.
Frank
F
Hoentjen
D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology*; D000328:Adult; D000714:Anastomosis, Surgical; D001005:Anus Neoplasms / Q000150:complications / Q000473:pathology*; D016022:Case-Control Studies; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000473:pathology / Q000601:surgery; D039021:Colonic Pouches / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology*; D003424:Crohn Disease / Q000150:complications / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000150:complications / Q000473:pathology*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011230:Precancerous Conditions / Q000473:pathology*; D016737:Proctocolectomy, Restorative; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
ATZ; Adenocarcinoma; CRC; HGD; IBD; IND; IPAA; Ileal Pouch-Anal Anastomosis; LGD; PALGA; Ulcerative Colitis; anal transitional zone; colorectal cancer; high-grade dysplasia; ileal pouch–anal anastomosis; indefinite for dysplasia; inflammatory bowel disease; low-grade dysplasia