S5 Characteristics and Outcomes of Patients With IBD Admitted to High vs Low Safety Net Burden Hospitals: A Nationwide Analysis

seen in both IBD and non-IBD patients, SEC is a distinct entity that has only been described in patients with IBD. It has also been termed hyperplastic-like change and ﬂ at serrated change. There is no standardized endoscopic appearance of SEC. Histologically, SECs have crypt distortionand lossof perpendicularorientationof cryptswithnotypicalfeaturesof dysplasia.Review of the current literature demonstrates di ﬀ ering opinions on the dysplasia risk associated with SEC. Brcic et al identi ﬁ ed mutations in KRAS and BRAF genes in several serrated lesions, that were not seen in mucosa with SEC, implying that the neoplastic potential is comparatively lower in SEC. However, a separate study of serrated lesions identi ﬁ ed evidence of aneuploidy that was present in TSA and SEC samples suggesting that there may be an association with neoplasia on a molecular level. From a clinical perspective, in 1 study of patients with SEC, 21% developed dysplasia over the observed 8-year period, suggesting a possible association between SEC and dysplasia, albeit not a causative one. A more recent case controlled study of 196 patients showed that in UC patients with SEC,therateofmetachronous/synchronousneoplasiawas26.5%comparedwith3.1%inUCpatientswithoutSEC.HighgradedyplasiawasalsoseenmorecommonlyinpatientswithUCandSEC (11.2%) compared with 2% in UC patients with SEC. This study concluded that due to this asso- ciation,closeattentionshouldbepaidonsubsequentsurveillancecolonoscopiestopatientswithSEC. Conclusion: Ultimately,furthercontrolledstudiesandprospectivetrialsareneededtoassessthetrue impact of SEC as a risk factor for dysplasia. This is still an under-recognized entity and the asso- ciations that have been noted in the recent studies suggest that closer endoscopic follow up may be necessary when SEC is revealed on surveillance biopsies.