BACKGROUND: Screening colonoscopy is a standard part of the liver transplant (LT) evaluation process. We aimed to evaluate the yield of screening colonoscopy and determine whether non-alcoholic fatty liver disease (NAFLD) was associated with an increased risk of colorectal neoplasia. METHODS: We retrospectively assessed all patients who completed LT evaluation at our center between 1/2008-12/2012. Patients <50 years old and those without records of screening colonoscopy, or with greater than average colon cancer risk were excluded. RESULTS: A total of 1,102 patients were evaluated, 591 met inclusion criteria and were analyzed. The mean age was 60 years, 67% were male, 12% had NAFLD and 88% had other forms of chronic liver disease. Overall, 42% of patients had a polyp found on colonoscopy: 23% with adenomas, 14% with hyperplastic polyps and with 1% inflammatory polyps. In the final multivariable model controlling for age, NAFLD [odds ratio (OR) 2.41, P=0.001] and a history of significant alcohol use (OR 1.69, P=0.004) were predictive of finding a polyp on colonoscopy. In addition, NAFLD (OR 1.95, P=0.02), significant alcohol use (OR 1.70, P=0.01) and CTP class C (OR 0.57, P=0.02) were associated with adenoma, controlling for age. CONCLUSIONS: Screening colonoscopy in patients awaiting LT yields a high rate of polyp (43%) and adenoma (22%) detection, perhaps preventing the accelerated progression to carcinoma that can occur in immunosuppressed post-LT patients. Patients with NAFLD may be at a ~2 fold higher risk of adenomas and should be carefully evaluated prior to LT.
BACKGROUND: Screening colonoscopy is a standard part of the liver transplant (LT) evaluation process. We aimed to evaluate the yield of screening colonoscopy and determine whether non-alcoholic fatty liver disease (NAFLD) was associated with an increased risk of colorectal neoplasia. METHODS: We retrospectively assessed all patients who completed LT evaluation at our center between 1/2008-12/2012. Patients <50 years old and those without records of screening colonoscopy, or with greater than average colon cancer risk were excluded. RESULTS: A total of 1,102 patients were evaluated, 591 met inclusion criteria and were analyzed. The mean age was 60 years, 67% were male, 12% had NAFLD and 88% had other forms of chronic liver disease. Overall, 42% of patients had a polyp found on colonoscopy: 23% with adenomas, 14% with hyperplastic polyps and with 1% inflammatory polyps. In the final multivariable model controlling for age, NAFLD [odds ratio (OR) 2.41, P=0.001] and a history of significant alcohol use (OR 1.69, P=0.004) were predictive of finding a polyp on colonoscopy. In addition, NAFLD (OR 1.95, P=0.02), significant alcohol use (OR 1.70, P=0.01) and CTP class C (OR 0.57, P=0.02) were associated with adenoma, controlling for age. CONCLUSIONS: Screening colonoscopy in patients awaiting LT yields a high rate of polyp (43%) and adenoma (22%) detection, perhaps preventing the accelerated progression to carcinoma that can occur in immunosuppressed post-LT patients. Patients with NAFLD may be at a ~2 fold higher risk of adenomas and should be carefully evaluated prior to LT.
Authors: J Sint Nicolaas; V De Jonge; E W Steyerberg; E J Kuipers; M E Van Leerdam; S J O Veldhuyzen-van Zanten Journal: Am J Transplant Date: 2010-04 Impact factor: 8.086
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Authors: J D Hardcastle; J O Chamberlain; M H Robinson; S M Moss; S S Amar; T W Balfour; P D James; C M Mangham Journal: Lancet Date: 1996-11-30 Impact factor: 79.321
Authors: Eric A Engels; Ruth M Pfeiffer; Joseph F Fraumeni; Bertram L Kasiske; Ajay K Israni; Jon J Snyder; Robert A Wolfe; Nathan P Goodrich; A Rana Bayakly; Christina A Clarke; Glenn Copeland; Jack L Finch; Mary Lou Fleissner; Marc T Goodman; Amy Kahn; Lori Koch; Charles F Lynch; Margaret M Madeleine; Karen Pawlish; Chandrika Rao; Melanie A Williams; David Castenson; Michael Curry; Ruth Parsons; Gregory Fant; Monica Lin Journal: JAMA Date: 2011-11-02 Impact factor: 157.335
Authors: Sarah S Comstock; Kari Hortos; Bruce Kovan; Sarah McCaskey; Dorothy R Pathak; Jenifer I Fenton Journal: PLoS One Date: 2014-01-17 Impact factor: 3.240
Authors: Amelie S Troschel; Alexander Miks; Fabian M Troschel; Anna Hüsing-Kabar; Miriam Maschmeier; Hauke S Heinzow; Hartmut H Schmidt; Iyad Kabar Journal: United European Gastroenterol J Date: 2019-01-21 Impact factor: 4.623