Original article
Systematic reviews and meta-analyses
Cancer Risk After Resection of Polypoid Dysplasia in Patients With Longstanding Ulcerative Colitis: A Meta-analysis

https://doi.org/10.1016/j.cgh.2013.07.024Get rights and content

Background & Aims

American and European guidelines propose complete endoscopic resection of polypoid dysplasia (adenomas or adenoma-like masses) in patients with longstanding colitis, with close endoscopic follow-up. The incidence of cancer after detection of flat low-grade dysplasia or dysplasia-associated lesion or mass is estimated at 14 cases/1000 years of patient follow-up. However, the risk for polypoid dysplasia has not been determined with precision. We investigated the risk of cancer after endoscopic resection of polypoid dysplasia in patients with ulcerative colitis.

Methods

MEDLINE, EMBASE, PubMed, and the Cochrane library were searched for studies of patients with colitis and resected polypoid dysplasia, with reports of colonoscopic follow-up and data on cancers detected. Outcomes from included articles were pooled to provide a single combined estimate of outcomes by using Poisson regression.

Results

Of 425 articles retrieved, we analyzed data from 10 studies, comprising 376 patients with colitis and polypoid dysplasia with a combined 1704 years of follow-up. A mean of 2.8 colonoscopies were performed for each patient after the index procedure (range, 0–15 colonoscopies). The pooled incidence of cancer was 5.3 cases (95% confidence interval, 2.7–10.1 cases)/1000 years of patient follow-up. There was no evidence of heterogeneity or publication bias. The pooled rate of any dysplasia was 65 cases (95% confidence interval, 54–78 cases)/1000 patient years.

Conclusion

Patients with colitis have a low risk of colorectal cancer after resection of polypoid dysplasia; these findings support the current strategy of resection and surveillance. However, these patients have a 10-fold greater risk of developing any dysplasia than colorectal cancer and should undergo close endoscopic follow-up.

Section snippets

Methods

The aim of this meta-analysis was to determine the rate of development of CRC in patients with longstanding ulcerative colitis who have had a polypoid dysplastic lesion resected and subsequently undergone colonoscopic surveillance.

Results

From the initial keyword search, 425 articles were selected and 1 Cochrane review. The Cochrane review did not contain any includable data not obtained from the original articles. Of the 425 head titles, 265 articles were selected. A second selection was made on abstract content, where 49 articles were further reviewed. These selected articles were scrutinized in depth. Forty-two studies did not meet the predefined inclusion or exclusion criteria. Finally, 7 articles were selected. From these

Discussion

This is a meta-analysis on CRC risk after resection of polypoid dysplasia in longstanding IBD. A total of 2.4% of patients developed CRC after an average follow-up of 54 months. The pooled CRC rate was 5.3 occurrences per 1000 patient years of follow-up from 10 studies including 376 patients and 1706 years of patient follow-up. The rate for any advanced lesion was 7 per 1000 patient years of follow-up, and the rate for any dysplasia was 65 occurrences per 1000 patient years. There was no

Acknowledgments

Data from this study were presented as an oral presentation on October 22 at United European Gastroenterology Week 2012, Amsterdam, and accepted for oral presentation on May 21 at Digestive Disease Week 2013, Orlando.

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    Conflicts of interest These authors disclose the following: Evelien Dekker received research funding and equipment on loan from Olympus. Simon P. L. Travis received consulting fees from Abbott, Asahi-Kasei, Bristol-Myers Squibb, Cosmo Technologies, Coronado Biosciences, Ferring Pharmaceuticals, Genentech, Genzyme Corp, GlaxoSmithKline, Janssen, Lexicon Pharmaceuticals, Merck Research Laboratories, Millennium Pharmaceuticals, Nisshin Kyorin Pharmaceuticals, Novartis, Novo Nordisk, NPS Pharmaceuticals, PDL Biopharma, Pfizer, Procter and Gamble, Santarus, Schering Plough, Shire Pharmaceuticals, Sigmoid Pharma Ltd, Tillotts Pharma AG, TxCell SA, UCB Pharma, and Warner Chilcott UK Ltd; research grants from Abbott, Genentech, GlaxoSmithKline, Janssen, Novartis, Pfizer, Procter and Gamble, Shire Pharmaceuticals, and UCB Pharma; payments for lectures/speakers bureaus from Abbott, Janssen, Ferring Pharmaceuticals, and Warner Chilcott; and holds no stock/stock options. James E. East is on the Advisory board at Cosmo Pharmaceuticals and is a speaker for Abbott Laboratories. The remaining authors disclose no conflicts.

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