Serrated colorectal polyps in inflammatory bowel disease

Area of Science:

• Gastroenterology
• Oncology
• Molecular Pathology

Background:

• Serrated colorectal polyps are precursors to a significant portion of sporadic colorectal cancers.
• The role and significance of serrated polyps in patients with inflammatory bowel disease (IBD) remain unclear.
• Understanding serrated polyp behavior in IBD is crucial for effective endoscopic surveillance.

Purpose of the Study:

• To evaluate the morphologic, clinicopathologic, and molecular features of serrated polyps in IBD patients.
• To compare the risk of advanced neoplasia development in IBD patients with serrated polyps versus those without.
• To determine the correlation between dysplasia grade in serrated polyps and patient/polyp characteristics and neoplasia risk.

Main Methods:

• Retrospective analysis of 78 serrated polyps from 6602 IBD patients over 14 years.
• Morphologic, clinicopathologic, and molecular (BRAF, KRAS mutations) analysis of polyps.
• Comparison of advanced neoplasia rates with IBD cohorts lacking serrated polyps.

Main Results:

• Serrated polyps negative for dysplasia (resembling sessile serrated adenomas) occurred in females, proximal colon, and had BRAF mutations.
• Serrated polyps with low-grade dysplasia (resembling traditional serrated adenomas) occurred in males, distal colon, and had KRAS mutations.
• Rates of prevalent and incident advanced neoplasia increased with higher dysplasia grades in serrated polyps.

Conclusions:

• Dysplasia grade in serrated polyps from IBD patients is associated with morphology, sex, location, and mutation status.
• Higher dysplasia grades correlate with increased risk of both prevalent and incident advanced neoplasia.
• Findings clarify the significance of serrated polyps in IBD surveillance and risk stratification.