Trends in Colorectal Dysplasia in Patients with Inflammatory Bowel Disease

BACKGROUND: Patients with inflammatory bowel disease face an elevated risk for early-onset colorectal cancer due to chronic inflammation and long-term immunosuppression. While immunotherapy improves disease control, its potential for increasing neoplastic transformation warrants further evaluation. OBJECTIVE: To characterize trends in incidence and clinical factors associated with dysplasia among IBD patients undergoing surgery. DESIGN: This is a retrospective cohort study. SETTING: High-volume United States IBD Centers participating in the American College of Surgeons National Surgery Quality Improvement Program IBD Collaborative, 2017-2023. PATIENTS: Adults with IBD undergoing colorectal surgery. Patients with missing covariate or outcome data were excluded. MAIN OUTCOME MEASURES: Prevalence of dysplasia (low-grade, high-grade, or carcinoma) on surgical pathology and associated risk factors. RESULTS: Among 5,516 IBD patients, dysplasia was identified in 4.3%. Prevalence was higher in patients with ulcerative colitis compared to those with Crohn's disease and indeterminate colitis (6.5% vs 3.2% vs 3.4%, respectively, p < 0.05), in those receiving immunotherapy (16.7% vs 12.0%, p = 0.02), and among Asian American patients (8.7% vs 4.5% White, 2.4% Black, p < 0.05). Female sex and older age (mean 53.9 vs 43.1 years) were also associated with increased dysplasia rates (p < 0.05). On multivariable logistic regression analysis, Asian American race (OR 2.54 [CI: 1.4-4.8]), immunotherapy use (OR 1.6 [CI: 1.1-2.3]) and ulcerative colitis (OR 2.0 [CI: 1.6-2.7]) were independently associated with dysplasia. A BMI <18.5 was inversely associated with risk (OR 0.4 [CI: 0.2-0.9]). LIMITATIONS: Data capture is limited to 30 days postoperatively and does not account for surgical indication or dysplasia chronicity. CONCLUSIONS: In patients undergoing surgery for IBD, immunotherapy use, Asian American race, ulcerative colitis, and older age were independently associated with colorectal dysplasia. These findings highlight the importance of tailored surveillance strategies in at-risk populations, particularly those receiving long-term immunosuppressive therapy. See Video Abstract.