SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Philippe SEKSIK
Coup de coeur :
 
 
Gastroenterology
  2019/04  
 
  2019 Apr;156(5):1333-1344.e3.  
  doi: 10.1053/j.gastro.2018.11.067.  
 
  No Association Between Pseudopolyps and Colorectal Neoplasia in Patients With Inflammatory Bowel Diseases.  
 
  Mahmoud R, Shah SC, Ten Hove JR, Torres J, Mooiweer E, Castaneda D, Glass J, Elman J, Kumar A, Axelrad J, Ullman T, Colombel JF, Oldenburg B, Itzkowitz SH; Dutch Initiative on Crohn and Colitis.  
  https://www.ncbi.nlm.nih.gov/pubmed/30529584  
 
 

Abstract

BACKGROUND & AIMS:

Patients with inflammatory bowel diseases who have postinflammatory polyps (PIPs) have an increased risk of colorectal neoplasia (CRN). European guidelines propose that patients with PIPs receive more frequent surveillance colonoscopies, despite limited evidence of this increased risk. We aimed to define the risk of CRN and colectomy in patients with inflammatory bowel diseases and PIPs.

METHODS:

We conducted a multicenter retrospective cohort study of patients with inflammatory bowel diseases who underwent colonoscopic surveillance for CRN, from January 1997 through January 2017, at 5 academic hospitals and 2 large nonacademic hospitals in New York or the Netherlands. Eligible patients had confirmed colonic disease with duration of at least 8 years (or any duration, if they also had primary sclerosing cholangitis) and no history of advanced CRN (high-grade dysplasia or colorectal cancer) or colectomy. The primary outcome was occurrence of advanced CRN according to PIP status; secondary outcomes were occurrence of CRN (inclusive of low-grade dysplasia) and colectomy.

RESULTS:

Of 1582 eligible patients, 462 (29.2%) had PIPs. PIPs were associated with more severe inflammation (adjusted odds ratio 1.32; 95% confidence interval [CI] 1.13-1.55), greater disease extent (adjusted odds ratio 1.92; 95% CI 1.34-2.74), and lower likelihood of primary sclerosing cholangitis (adjusted odds ratio 0.38; 95% CI 0.26-0.55). During a median follow-up period of 4.8 years, the time until development of advanced CRN did not differ significantly between patients with and those without PIPs. PIPs did not independently increase the risk of advanced CRN (adjusted hazard ratio 1.17; 95% CI 0.59-2.31). The colectomy rate was significantly higher in patients with PIPs (P = .01).

CONCLUSIONS:

In a retrospective analysis of data from 2 large independent surveillance cohorts, PIPs were associated with greater severity and extent of colon inflammation and higher rates of colectomy, but were not associated with development of any degree of CRN. Therefore, intervals for surveillance should not be shortened based solely on the presence of PIPs.

 

 
Question posée
 
La présence de pseudopolypes au cours d’une coloscopie de surveillance de MICI colique est-elle un facteur de risque de cancer colorectal ?
 
Question posée
 
Non.
 
Commentaires

Enfin une étude d’envergure dédiée aux pseudopolypes et à leur risque éventuel néoplasique ! En effet dans la plupart des études endoscopiques sur le risque néoplasique au cours de MICI coliques les patients ayant des pseudopolypes sont systématiquement exclus. Ici, au contraire, la présence pseudoplypes est rapportée dans plusieurs cohortes. Cette étude rétrospective internationale (USA, Pays-bas) a inclus environ 1600 patients ayant des coloscopies de surveillance pour MICI. Même si la définition des pseudopolypes (appelés par les auteurs polypes post-inflammation) n’était pas standardisée cette étude est remarquable par la taille de l’effectif. Certains biais inhérents au caractère rétrospectif n’empêchent pas considérer ce travail comme solide. Il semble que la présence de pseudopolypes soit in fine plutôt associée à un profil inflammatoire de la maladie plutôt qu’à un risque de néoplasie. Il faudra probablement mieux définir dans le futur la nature des polypes, leur biologie et prendre en compte leur nombre pour estimer au mieux l’impact des pseudopolypes au cours des MICI.

 
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