Babu P Mohan1, Shahab R Khan2, Saurabh Chandan3, Lena L Kassab4, Suresh Ponnada5, Ravishankar Asokkumar6, Bo Shen7, Marietta Iacucci8, Udayakumar Navaneethan9. 1. Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA. 2. Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA. 3. Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA. 4. Internal Medicine, Mayo Clinic, Rochester, Minneapolis, USA. 5. Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA. 6. Gastroenterology and Hepatology, Singapore General Hospital, Singapore. 7. IBD Center, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA. 8. Institute Translational of Medicine, Institute of Immunology and Immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 9. IBD Center, AdventHealth, Orlando, Florida, USA.
Abstract
BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) is a well-known risk factor for colorectal cancer (CRC). Current guidelines propose complete endoscopic resection of dysplasia in IBD patients with close endoscopic follow-up. Current data on the risk of neoplasia after endoscopic resection of dysplasia in IBD patients are limited. METHODS: Multiple databases were searched from inception through August 2019 to identify studies that reported on incidence and/or recurrence of neoplasia after resection of dysplasia in patients with IBD. Outcomes from the included studies were pooled to estimate the risk of neoplasia after dysplasia resection in IBD patients. RESULTS: From 18 studies, 1037 IBD patients underwent endoscopic resection for a total of 1428 colonic lesions. After lesion resection, the pooled risk (rate per 1000 person-years of follow-up) of CRC was 2 (95% confidence interval [CI], 0-3), the pooled risk of high-grade dysplasia was 2 (95% CI, 1-3), and the pooled risk of any lesion was 43 (95% CI, 30-57). Meta-regression analysis based on lesion location (right, left), lesion size (mean and/or median size in mm), lesion type (Paris type I, Paris type II), endoscopic resection technique (EMR, endoscopic submucosal dissection, or polypectomy), and lesion histology (low-grade dysplasia, high-grade dysplasia) did not influence the reported outcomes. CONCLUSIONS: Risk of CRC after dysplasia resection in IBD patients appears to be low, supporting the current strategy of resection and surveillance.
BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) is a well-known risk factor for colorectal cancer (CRC). Current guidelines propose complete endoscopic resection of dysplasia in IBDpatients with close endoscopic follow-up. Current data on the risk of neoplasia after endoscopic resection of dysplasia in IBDpatients are limited. METHODS: Multiple databases were searched from inception through August 2019 to identify studies that reported on incidence and/or recurrence of neoplasia after resection of dysplasia in patients with IBD. Outcomes from the included studies were pooled to estimate the risk of neoplasia after dysplasia resection in IBDpatients. RESULTS: From 18 studies, 1037 IBDpatients underwent endoscopic resection for a total of 1428 colonic lesions. After lesion resection, the pooled risk (rate per 1000 person-years of follow-up) of CRC was 2 (95% confidence interval [CI], 0-3), the pooled risk of high-grade dysplasia was 2 (95% CI, 1-3), and the pooled risk of any lesion was 43 (95% CI, 30-57). Meta-regression analysis based on lesion location (right, left), lesion size (mean and/or median size in mm), lesion type (Paris type I, Paris type II), endoscopic resection technique (EMR, endoscopic submucosal dissection, or polypectomy), and lesion histology (low-grade dysplasia, high-grade dysplasia) did not influence the reported outcomes. CONCLUSIONS: Risk of CRC after dysplasia resection in IBDpatients appears to be low, supporting the current strategy of resection and surveillance.