{
  "abstract": "Background Villous changes defined as indiscrete villous mucosal endoscopic appearance and villous changes in histology in patients with inflammatory bowel disease (IBD), are increasingly recognised. Their clinical significance remains uncertain, particularly regarding risk of progression to dysplasia, optimal surveillance strategies, standardized endoscopic characterization, consensus terminology, and histopathological correlation.Methods Retrospective study of IBD patients with endoscopic and/or histologic villous changes (2021–2022), with follow-up to 2025. Data were collected from routine colonoscopies for assessment or surveillance, including clinical characteristics and surveillance outcomes.Results 49 patients (mean age 43 years; 59% male) with ulcerative colitis (76%), Crohn’s disease (18%), indeterminate colitis (6%). Baseline characteristics ( table 1).Villous changes were identified endoscopically in 23 patients (targeted biopsies) and histologically in 26 patients (random biopsies without visible lesion).10 patients had surgery within 1 year after index procedure, of whom 4 had dysplasia in the context of villous changes (8%). 2 patients died after index procedure for non-related causes, and 4 had no follow-up. 32 patients (65%) underwent risk-stratified surveillance. 6 patients had dysplasia identified at index procedure; histologic findings summarised in table 1.During median 3-year follow-up (IQR 2–3), 4/32 patients (13%) developed new dysplasia; 2 at the same site as prior villous changes. 2/32 (6%) had dysplasia at index and did not show progression; 2/32 (6%) were classified as indefinite for dysplasia, and 20/32 (62%) remained free of dysplasia or persistent villous changes. Overall, 10/49 patients (20.4%) had synchronous or metachronous dysplasia associated with villous changes during follow-up.Conclusion In this real-world cohort, risk-stratified surveillance of IBD patients with villous changes was associated with dysplasia progression in only a minority of patients. The inconsistent correlation between endoscopic and histologic findings highlights the need for multidisciplinary consensus on reporting terminology and surveillance strategies.Abstract P234 Table 1Baseline characteristicsn (%)Total49Age, mean (years)43SexFemale20 (41%)Male29 (59%)IBD subtypeUlcerative colitis37 (76%)Crohn’s disease9 (18%)Indeterminate colitis3 (6%)Primary sclerosing cholangitis4 (8%)Baseline therapyBiologics26 (53%)Tofacitinib1 (2%)5-ASA13 (27%)Steroids2 (4%)No therapy7 (14%)Mayo Score at index colonoscopySevere15 (31%)Moderate14 (29%)Mild8 (16%)Quiescent11 (22%)Index procedure endoscopistIBD specialist/BCSP endoscopist57%Non-specialist doctor43%Histology at Index Procedure Active inflammation only5 (10%)Dysplasia6 (12%)Non-conventional serrated dysplasia1 (2%)Sessile serrated lesion1 (2%)Hyperplastic changes3 (6%)Indefinite for dysplasia4 (8%)Villous changes30 (61%)",
  "authors": [
    {
      "affiliations": [
        "University College Hospital, London, United Kingdom"
      ],
      "name": "Laura Lorenzo Gonzalez"
    },
    {
      "affiliations": [
        "Royal Free London NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "William Waddingham"
    },
    {
      "affiliations": [
        "University College Hospital, London, United Kingdom"
      ],
      "name": "Misha Kabir"
    },
    {
      "affiliations": [
        "University College Hospital, London, United Kingdom"
      ],
      "name": "Edward Seward"
    }
  ],
  "title": "P234 Do endoscopic indiscrete villous changes correlate with neoplastic progression?",
  "uid": "0dcb5b76-8b1e-5113-a947-e51fb0633000"
}