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Master Thesis

Prédicteurs de première lésion néoplasique colique chez les patients surveillés par coloscopies itératives pour maladie inflammatoire chronique intestinale

Abstract : Introduction: Little is known about risk factors of first colorectal neoplasia (CRN) in inflammatory bowel diseases (IBD) patients after a surveillance colonoscopy without dysplasia. The aims of our study were to assess the risk for first CRN in this population and to search for protective and risk factors for CRN. Methods: All consecutive patients who have undergone at least 2 colonoscopies at Saint Antoine Hospital between 01/01/1996 and 31/03/2015 and whose first procedure was a surveillance colonoscopy were included. A nested case-cohort study was performed to assess risk factors of CRN developed in inflamed mucosa. Results: 404 patients with a total of 1236 colonoscopies were included. The cumulative risk of CRN was 22.6% at 10 years. 38 patients with CRN developed in inflamed mucosa and 92 controls were included in the nested case control study. In multivariate analysis, primary sclerosing cholangitis (PSC) (Odds ratio (OR), 6.26; CI 95% 1.07-36.8; p=0.04), neutrophils or cryptic abscess present on over half of colonoscopies (OR, 8.77; CI 95% 1.71-45; p=0.009) and glandular distortions present on over half of colonoscopies (OR, 8.09; CI 95% 1.21-54.3 ; p=0.03) were positively associated with CRN, whereas thiopurines (OR, 0.18; CI 95% 0.047-0.698; p=0.01) and aminosalicylates (OR, 0.27; CI 95% 0.084-0.876; p=0.03) reduced the risk for CRN. Conclusion: Occurrence of first CRN was associated with PSC, persistence of acute and chronic inflammation. Administration of thiopurines and aminosalicylates reduced risk of first CRN. Surveillance colonoscopy intervals after a surveillance colonoscopy without dysplasia should take into account these parameters.
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Julien Kirchgesner. Prédicteurs de première lésion néoplasique colique chez les patients surveillés par coloscopies itératives pour maladie inflammatoire chronique intestinale. Médecine humaine et pathologie. 2015. ⟨dumas-01252414⟩

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