title: Pattern of Inflammation on Surveillance Colonoscopy Does Not Predict Development of Colitis-associated Neoplasia.
abstract: Identification of colonoscopic features which increase colitis-associated neoplasia risk in patients with ulcerative colitis (UC) may allow patient risk stratification. Our objective was to investigate whether colonoscopic features correlate with the risk of developing colitis-associated neoplasia in patients with UC on surveillance.
  
  
  
  In this retrospective case-control study, patients with UC who underwent surveillance colonoscopies from 1998 to 2011 were included. Patients with UC with neoplasia were compared with a matched control group of patients with UC without neoplasia in a 1:3 ratio.
  
  
  
  A total of 111 eligible patients with UC with colon neoplasia were compared with 356 patients with UC without colon neoplasia. On univariate analysis, colitis-associated neoplasia was associated with male gender (odds ratio [OR] = 2.58, 95% confidence interval [CI]: 1.71-3.89, P ≤ 0.001) and smoking history (OR = 1.62, 95% CI: 1.1-2.39, P = 0.045) but not with colonoscopic features, including tubular colon/shortened colon, scarring, segment of severe inflammation, inflammatory polyps, colonic stricture, or macroscopically normal appearance colonoscopy. In multivariate analysis, only male gender (OR = 2.68, 95% CI: 1.77-4.08, P ≤ 0.001) was found to be associated with an increased risk, whereas the use of 5-aminosalicylates was associated with a decreased risk for colitis-associated neoplasia (OR = 0.51, 95% CI: 0.31-0.84, P = 0.009).
  
  
  
  In patients with UC, colonoscopic features especially on standard-definition white-light colonoscopy did not appear to reliably predict the development of colitis-associated neoplasia. This will leave room for image-enhanced endoscopy technology and molecular markers for the early and accurate detection of colitis-associated neoplasia.
authors.affiliation: *Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio; and †Center for Interventional Endoscopy, Florida Hospital Institute for Minimally Invasive Therapy, Orlando, Florida.
authors.forename: Ramprasad
authors.initials: R
authors.lastname: Jegadeesan
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Norma G
authors.initials: NG
authors.lastname: Gutierrez
authors.forename: Preethi G K
authors.initials: PG
authors.lastname: Venkatesh
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Hammel
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000209:etiology*; D003111:Colonic Polyps / Q000175:diagnosis / Q000473:pathology; D003113:Colonoscopy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000175:diagnosis*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D011230:Precancerous Conditions; D012189:Retrospective Studies; D012737:Sex Factors; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine