Significance of serrated epithelial change in inflammatory bowel disease

ABSTRACT

Objectives

The clinical significance of hyperplastic polyp-like histologic changes in random biopsy samples (‘serrated epithelial change’ or SEC) from patients with inflammatory bowel disease (IBD) remains uncertain, with some studies suggesting an increased risk of dysplasia and even carcinoma. Controlled studies are few. We studied the significance of SEC on the development of dysplasia in follow-up surveillance of IBD patients in our system.

Methods

We identified 94 IBD patients with SEC and 187 IBD patients without SEC identified in index biopsy samples, and retrospectively collated results of follow-up surveillance samples in each group, with the development of dysplasia and/or adenocarcinoma as study endpoints.

Results

IBD patients with SEC had a 12.8% likelihood of developing dysplasia of any type within IBD-affected areas vs a 4.3% likelihood in non-SEC patients (follow-up in the 1–4 year range for each group). This was significant in univariate analysis (p = 0.013) but not in multivariate analysis, likely due to increased frequency of follow-up sampling in the SEC patients. One cancer developed in each group (p = NS).

Conclusion

Our data, in the context of other studies, neither prove nor conclusively exclude an increased risk of dysplasia in IBD patients with SEC. But cancer risk appears low and continued surveillance at usual intervals seems reasonable.

KEYWORDS:

• Dysplasia
• colon
• inflammatory bowel disease
• serrated epithelial change

Acknowledgments

Special thanks to Amy Beckman, M.D. for help in manuscript preparation and to Dr. Dale Snover for critical review and comments. This study was reviewed by the Western Institutional Review Board and deemed exempt.

Steve Mongin assisted in the statistical analysis during the abstract stage.

Declaration of interest

The authors have received support from Minnesota Gastroenterology and Hospital Pathology Associates.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.