Intestinal Research

Original Articles

IBD

Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by biopsy: Ryoya Sakakibara, Shinya Sugimoto, Kaoru Takabayashi, Hiroki Kiyohara, Yusuke Wakisaka, Yuta Kaieda, Miho Kawaida, Yusuke Yoshimatsu, Tomohisa Sujino, Naoki Hosoe, Motohiko Kato, Masayuki Shimoda, Yohei Mikami, Yasushi Iwao, Takanori Kanai; Intest Res 2024;22(4):428-438. Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2024.00006

Background/Aims
Poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma (por/sig/muc), which are considered to be histologic subtypes with a poor prognosis, occur more frequently with colitis-associated cancer than with sporadic tumors. However, their invasiveness and manifestations are unclear. This study aimed to determine the prevalence of the por/sig/muc component in ulcerative colitis-associated neoplasms (UCANs) and its association with invasiveness and to clarify its clinicohistologic and endoscopic features.
Methods
This retrospective observational study included patients diagnosed with ulcerative colitis-associated high-grade dysplasia or adenocarcinoma from 1997 to 2022 who were divided according to the presence or absence of a por/sig/muc component.
Results
Thirty-five patients had UCAN with a por/sig/muc component and 66 had UCAN without this component. The 5-year survival rate was significantly lower in the por/sig/muc group than in the tub group (67% vs. 96%, P= 0.001), which was attributed to disease above stage III and depth to below the subserosa. Biopsy-based diagnosis before resection detected a por/sig/muc component in only 40% of lesions (14/35). Lesions with a por/sig/muc component were prevalent even in the early stages: stage 0 (4/36, 11%), I (8/20, 40%), II (7/12, 58%), III (10/14, 71%), and IV (6/8, 75%).
Conclusions
This is the first investigation that shows UCANs with a por/sig/muc component tended to be deeply invasive and were often not recognized preoperatively. Endoscopists should be aware that UCAN often has a por/sig/muc component that is not always recognized on biopsy, and the optimal treatment strategy needs to be carefully considered.

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Underestimation of the horizontal extent of ulcerative colitis-associated neoplasia may lead to incomplete endoscopic resection and subsequent recurrence
Soichiro Murakami, Shinya Sugimoto, Yasushi Iwao, Kaoru Takabayashi, Hiroki Kiyohara, Yusuke Yoshimatsu, Ryoya Sakakibara, Yuta Kaieda, Arina Shigehara, Naoki Hosoe, Motohiko Kato, Yohei Mikami, Takanori Kanai
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef
Adjustment of Surveillance Intervals for Ulcerative Colitis‐Associated Neoplasia Based on Disease Duration
Ryoya Sakakibara, Shinya Sugimoto, Yuta Kaieda, Hiroki Kiyohara, Yusuke Yoshimatsu, Kaoru Takabayashi, Soichiro Murakami, Miho Kawaida, Tomohisa Sujino, Naoki Hosoe, Motohiko Kato, Yasushi Iwao, Yohei Mikami, Takanori Kanai
Digestive Endoscopy.2025; 37(10): 1068. CrossRef
Characterization of Computed Tomography Colonography Findings of Ulcerative Colitis-Associated Neoplasia
Yuta Kaieda, Shinya Sugimoto, Tatsuya Suzuki, Shunsuke Matsumoto, Hiroki Kiyohara, Kaoru Takabayashi, Yusuke Yoshimatsu, Koji Okabayashi, Kohei Shigeta, Ryoya Sakakibara, Yusuke Wakisaka, Soichiro Murakami, Masahiro Jinzaki, Yasushi Iwao, Yohei Mikami, Ta
Inflammatory Bowel Diseases.2025;[Epub] CrossRef

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Role of random biopsies in surveillance of dysplasia in ulcerative colitis patients with high risk of colorectal cancer: Sawan Bopanna, Maitreyee Roy, Prasenjit Das, S Dattagupta, V Sreenivas, V Pratap Mouli, Saurabh Kedia, Rajan Dhingra, Rajesh Pradhan, N Suraj Kumar, Dawesh P Yadav, Govind Makharia, Vineet Ahuja; Intest Res 2016;14(3):264-269. Published online June 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.3.264

Abstract PDF PubReader ePub

Background/Aims

Recent data suggest that the incidence of ulcerative colitis (UC) related colorectal cancer (CRC) in India is similar to that of West. The optimum method for surveillance is still a debate. Surveillance with random biopsies has been the standard of care, but is a tedious process. We therefore undertook this study to assess the yield of random biopsy in dysplasia surveillance.

Methods

Between March 2014 and July 2015, patients of UC attending the Inflammatory Bowel Disease clinic at the All India Institute of Medical Sciences with high risk factors for CRC like duration of disease >15 years and pancolitis, family history of CRC, primary sclerosing cholangitis underwent surveillance colonoscopy for dysplasia. Four quadrant random biopsies at 10 cm intervals were taken (33 biopsies). Two pathologists examined specimens for dysplasia, and the yield of dysplasia was calculated.

Results

Twenty-eight patients were included. Twenty-six of these had pancolitis with a duration of disease greater than 15 years, and two patients had associated primary sclerosing cholangis. No patient had a family history of CRC. The mean age at onset of disease was 28.89±8.73 years and the duration of disease was 19.00±8.78 years. Eighteen patients (64.28%) were males. A total of 924 biopsies were taken. None of the biopsies revealed any evidence of dysplasia, and 7/924 (0.7%) were indefinite for dysplasia.

Conclusions

Random biopsy for surveillance in longstanding extensive colitis has a low yield for dysplasia and does not suffice for screening. Newer techniques such as chromoendoscopy-guided biopsies need greater adoption.

Citations

Citations to this article as recorded by

Interlukin-23 inhibitors as an induction and maintenance therapy for moderate to severe ulcerative colitis: a systematic review and meta‑analysis of randomized controlled trials
Omar Saab, Hasan Al-Obaidi, Marwah Algodi, Asma Algodi, Yasir Rashid, Alhareth Al-Sagban, Hayder Alamily, Nooraldin Merza, Layth Alzubaidy, Andrew DuPont
Inflammation Research.2025;[Epub] CrossRef
Etrolizumab as an induction and maintenance therapy for ulcerative colitis: A systematic review and meta‐analysis of randomized controlled trials
Othman Saleh, Mohamed T. Abuelazm, Islam Mohamed, Alaa Ramadan, Mohammad Assaf, Ahmad Alzoubi, Majd M. AlBarakat, Basel Abdelazeem
JGH Open.2024;[Epub] CrossRef
Low prevalence of primary sclerosing cholangitis in patients with inflammatory bowel disease in India
Arshdeep Singh, Vandana Midha, Vikram Narang, Saurabh Kedia, Ramit Mahajan, Pavan Dhoble, Bhavjeet Kaur Kahlon, Ashvin Singh Dhaliwal, Ashish Tripathi, Shivam Kalra, Narender Pal Jain, Namita Bansal, Rupa Banerjee, Devendra Desai, Usha Dutta, Vineet Ahuja
Intestinal Research.2023; 21(4): 452. CrossRef
Colorectal Cancer Surveillance in Patients with Inflammatory Bowel Diseases: Chromoendoscopy or Non-Chromoendoscopy, That Is the Question
Roberto Gabbiadini, Ferdinando D’Amico, Alessandro De Marco, Maria Terrin, Alessandra Zilli, Federica Furfaro, Mariangela Allocca, Gionata Fiorino, Silvio Danese
Journal of Clinical Medicine.2022; 11(3): 509. CrossRef
Endoscopic Surveillance in Inflammatory Bowel Diseases: Selecting a Suitable Technology
Arianna Dal Buono, Roberto Gabbiadini, Federica Furfaro, Marjorie Argollo, Thaís Viana Tavares Trigo, Alessandro Repici, Giulia Roda
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Heterogeneity of Colorectal Cancer Progression: Molecular Gas and Brakes
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Histopathological study of endoscopic biopsies of large intestine
Manjiri N Karandikar, Purva Kulkarni, Smita Mulay, R C Nimbergi, N S Mani
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Is histological remission of ulcerative colitis achievable?
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Oleg V. Knyazev, Sergey G. Khomeriki, Аnna V. Kagramanova, Albina A. Lishchinskaya, Olga A. Smirnova, Karina K. Noskova, Asfold I. Parfenov
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Can histologic remission be a better prognostic factor and therapeutic target beyond endoscopic mucosal healing in patients with ulcerative colitis?
Hyo Jun Ahn, Sang-Bum Kang
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Screening strategy for colorectal cancer according to risk
Dong Soo Han
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Systematic Review

Histological inflammation increases the risk of colorectal neoplasia in ulcerative colitis: a systematic review: Ruben J. Colman, David T. Rubin; Intest Res 2016;14(3):202-210. Published online June 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.3.202

Abstract PDF PubReader ePub

Background/Aims

Ulcerative colitis (UC) patients are at greater risk for the development of colorectal neoplasia. Several individual studies have demonstrated associations between severity of histologic inflammation and colorectal neoplasia. However, a comprehensive systematic review has not been completed. We performed a systematic review and meta-analysis to explore the relationship between histologic inflammation and risk for neoplasia among available observational studies.

Methods

Three databases (EMBASE, MEDLINE and the Cochrane Library) were systematically searched. Studies were included if they included UC patients who underwent colonoscopic assessment and when histologic inflammation and colorectal neoplasia were both reported. Colorectal neoplasia rates were compared. Quantitative meta-analysis was attempted.

Results

Four of 1,422 records found were eligible. Results from 2 case-control studies reported a 3.5-fold increased risk for colorectal neoplasia associated with a single point increase in histologic inflammation. This result was further corroborated by one cohort study that demonstrated increased hazard ratios. The second cohort study reported outcomes for patients with normal gross endoscopy, but had increased histological inflammation when neoplasia was assessed. Finally, this study reported increased risk for neoplastic progression by histological inflammation among patients who were normal by gross endoscopic evaluation. Quantitative meta-analysis was unsuccessful due to heterogeneity between study measures.

Conclusions

There is strong evidence that histologic inflammation among patients with UC increases the risk of colorectal neoplasia. The depth and nature of assessment of additional clinical variables was varied and may have resulted in greater outcome discrepancy. Additional study related to mechanisms of inflammation-related neoplasia and therapeutic modification is needed.

Citations

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Original Article

The role of capsule endoscopy in etiological diagnosis and management of obscure gastrointestinal bleeding: Vikas Pandey, Meghraj Ingle, Nilesh Pandav, Pathik Parikh, Jignesh Patel, Aniruddha Phadke, Prabha Sawant; Intest Res 2016;14(1):69-74. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.69

Abstract PDF PubReader ePub

Background/Aims

To investigate the various etiologies, yields, and effects of capsule endoscopy (CE) on management and complications, along with follow up of patients with obscure gastrointestinal (GI) bleeding.

Methods

The study group of patients included those having obscure, overt, or occult GI bleeding. The findings were categorized as (A) obvious/definitive, (B) equivocal, or (C) negative. Any significant alteration in patient management post CE in the form of drug or surgical intervention was noted.

Results

Total patients included in the study were 68 (48 males and 20 females). The ratio of male:female was 2.4:1. The age ranged between 16 years to 77 years. Mean age for males was 62±14 years, for females 58±16 years. The total yield of CE with definitive lesions was in 44/68 (65.0%) of patients. In descending order (A) angiodysplasia 16/68 (23.53%), (B) Crohn's disease 10/68 (14.70%), (C) non-steroidal anti-inflammatory drug enteropathy 8/68 (11.76%), (D) small bowel ulcers 4/68 (5.88%), (E) jejunal and ileal polyps 2/68 (2.94%), (F) intestinal lymphangiectasis 2/68 (2.94%), and (G) ileal hemangiomas 2/68 (2.94%) were followed. Equivocal findings 12/68 (17.65%) and negative study 12/68 (17.65%) was found. Complications in the form of capsule retention in the distal ileum were noted in 2/68 (2.94%) subjects. Statistically, there was a higher probability of finding the etiology if the CE was done during an episode of bleeding.

Conclusions

CE plays an important role in diagnosing etiologies of obscure GI bleeding. Its role in influencing the management outcome is vital.

Citations

Citations to this article as recorded by

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