Association of preoperative neoplasia and rectal cuff inflammation on initial pouchoscopy with subsequent neoplasia development in inflammatory bowel disease patients with an ileal pouch-anal anastomosis: a case-control study.

BACKGROUND AND AIMS: Neoplasia of the pouch or rectal cuff is a rare cause of pouch failure in patients with an ileal pouch-anal anastomosis. Cuff inflammation has been suggested to convey a higher neoplasia risk but has not been thoroughly investigated. This study evaluated whether endoscopic inflammation of the rectal cuff conveys increased risk of subsequent neoplasia development. METHODS: This was a 2-institution case-control study of inflammatory bowel disease patients who developed neoplasia of the rectal cuff or ileal pouch and patients without neoplasia. Cases were matched to controls in a 1:4 ratio. Neoplasia was defined as dysplasia or adenocarcinoma, and cuff inflammation was defined as endoscopic evidence of erythema, edema, and/or ulcerations. A subanalysis assessed whether persistent inflammation conveys a higher neoplasia risk than resolved cuff inflammation. RESULTS: Forty-six cases of neoplasia were matched to 184 controls. Rectal cuff dysplasia (n = 23) was most common, followed by pouch dysplasia, cuff cancer, pouch cancer, and neoplasia involving both sites. Patients with cuff inflammation on initial pouchoscopy (adjusted odds ratio aOR = 2.82; 95% CI, 1.24-7.74; P = .013) had a higher risk of developing neoplasia. Compared to controls, patients with persistent cuff inflammation had a higher risk of neoplasia development (aOR = 3.70; 95% CI, 1.37-9.97; P = .010), but this trend was not observed in patients with inflammation on only one pouchoscopy. CONCLUSIONS: Patients with inflammation of the rectal cuff on initial pouchoscopy are at higher risk of subsequent neoplasia development, and this risk appears highest in patients with persistent inflammation.