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.
Powers et al. (Tue,) studied this question.