Abstract
Background and Aims
Microscopic colitis (MC) is the most frequent condition in subjects undergoing ileocolonoscopy
for chronic non-bloody diarrhea (CNBD) in Western countries. Emerging evidence has
shown a negative association between MC and colorectal cancer. Within this prospective
multi-center study we have evaluated the risk of colorectal neoplasia in MC and non-MC
patients with CNBD receiving ileocolonoscopy with high-definition plus virtual chromoendoscopic
imaging and histopathological assessment.
Methods
Patients with CNBD of unknown origin were prospectively enrolled in 5 referral centers
in Northern Italy for ileocolonoscopy with high-definition and digital/optical chromoendoscopy
plus multiple biopsies in each segment. The prevalence of colorectal neoplasia (cancer,
adenoma, serrated lesion) in MC was compared to that observed in a control group including
CNBD patients negative for MC, inflammatory bowel disease or eosinophilic colitis.
Results
From 2014 and 2017, 546 consecutive CNBD patients were recruited. Among the 492 patients
(mean age 53±18 years) fulfilling the inclusion criteria against the exclusion critieria,
MC was the predominant diagnosis at histopathological assessment (8.7%: N=43, 28 CC, 15 LC). The regression model adjusted for age and gender showed a significant
negative association between the diagnosis of CM and colorectal neoplasia (OR=0.39;
95% CI 0.22−0.67, p <0.001) with a 60% decreased risk of adenomatous and neoplastic serrated polyps as
compared to the control group (n=412).
Conclusion
This multi-center study confirms MC as a low-risk condition for colorectal neoplasia.
No surveillance colonoscopy program is to be performed for MC diagnosis.
Keywords
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Article info
Publication history
Published online: October 28, 2020
Accepted:
September 24,
2020
Received:
April 2,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
