No Association Between Pseudopolyps and Colorectal Neoplasia in Patients With Inflammatory Bowel Diseases

BACKGROUND & AIMS: Patients with inflammatory bowel diseases (IBD) who have post-inflammatory 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 IBD and PIPs. METHODS: We conducted a multicenter retrospective cohort study of patients with IBD who underwent colonoscopic surveillance for CRN, from January 1997 through January 2017, at 5 academic hospitals and 2 large non-academic hospitals in New York or the Netherlands. Eligible patients had confirmed colonic disease with duration of 8 years or more (or any duration, if they also have primary sclerosing cholangitis) and no prior 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: Among 1582 eligible patients, 462 patients (29.2%) had PIPs. PIPs were associated with more severe inflammation (adjusted odds ratio [aOR], 1.32; 95% CI, 1.13–1.55), greater disease extent (aOR 1.92; 95% CI, 1.34–2.74), and lower likelihood of primary sclerosing cholangitis (aOR 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 vs without PIPs. PIPs did not independently increase 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=0.01). 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 solely based on the presence of PIPs.