Risk of Neoplasia After Colectomy in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Derikx, Lauranne; Nissen, Loes H C; Smits, Lisa J T; Shen, Bo; Hoentjen, Frank

doi:10.1016/j.cgh.2015.08.042

Cited by 75 publications

(70 citation statements)

References 84 publications

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“…Current recommendations suggest starting surveillance colonoscopy immediately after diagnosis and following with annual follow-up. 67 Ursodeoxycholic acid (UDCA) has shown some benefit in reducing colonic dysplasia in this population: this effect can be related to effect in reducing reduced colonic concentra-tion of deoxycholic acid. 68 However, the CRC risk persists after orthotopic liver transplantation.…”

Section: Special Conditionsmentioning

confidence: 99%

“…Risk factors for developing dysplasia after IPAA surgery include history of dysplasia or CRC, history of PSC, refractory pouchitis, and atrophic pouch mucosa with severe inflammation. 67,68 Considering these factors, patients with a history of prior CRC, PSC, or refractory pouchitis should undergo annual surveillance, with biopsies being obtained in the pouch as well as distally within the anal transition zone. 34 The ideal timing for surveillance in patients with pouch and without risk factors following an IPAA is still unknown.…”

Section: Special Conditionsmentioning

confidence: 99%

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Colorectal Cancer in Inflammatory Bowel Disease

Nebbia

Yassin

Spinelli

2020

Clin Colon Rectal Surg

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Patients with inflammatory bowel disease (IBD) are at an increased risk for developing colorectal cancer (CRC). However, the incidence has declined over the past 30 years, which is probably attributed to raise awareness, successful CRC surveillance programs and improved control of mucosal inflammation through chemoprevention. The risk factors for IBD-related CRC include more severe disease (as reflected by the extent of disease and the duration of poorly controlled disease), family history of CRC, pseudo polyps, primary sclerosing cholangitis, and male sex. The molecular pathogenesis of inflammatory epithelium might play a critical role in the development of CRC. IBD-related CRC is characterized by fewer rectal tumors, more synchronous and poorly differentiated tumors compared with sporadic cancers. There is no significant difference in sex distribution, stage at presentation, or survival. Surveillance is vital for the detection and subsequently management of dysplasia. Most guidelines recommend initiation of surveillance colonoscopy at 8 to 10 years after IBD diagnosis, followed by subsequent surveillance of 1 to 2 yearly intervals. Traditionally, surveillance colonoscopies with random colonic biopsies were used. However, recent data suggest that high definition and chromoendoscopy are better methods of surveillance by improving sensitivity to previously “invisible” flat dysplastic lesions. Management of dysplasia, timing of surveillance, chemoprevention, and the surgical approaches are all areas that stimulate various discussions. The aim of this review is to provide an up-to-date focus on CRC in IBD, from laboratory to bedside.

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Section: Special Conditionsmentioning

confidence: 99%

Section: Special Conditionsmentioning

confidence: 99%

Colorectal Cancer in Inflammatory Bowel Disease

Nebbia

Yassin

Spinelli

2020

Clin Colon Rectal Surg

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“…Even among patients with an ileoanal pouch, 57% of cancers arose in patients with prior colorectal neoplasia. 7 However, it is important to note that most pouch cancers arise from the residual anorectal mucosa in these patients rather than the pouch mucosa itself. In a systematic review of 34 patients reporting on 49 patients with cancer after IPAA, two-thirds of cancers arose in the anorectal mucosa.…”

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confidence: 99%

“…The magnitude of this risk, particularly by type of procedure, has so far been poorly understood. In this issue of the journal, Derikx et al 7 have put in an impressive effort to systematically review the published literature to estimate the prevalence, incidence, and risk factors for colorectal neoplasia in patients after colectomy with IPAA, IRA, and rectal stump surgery. On the basis of 33 studies reporting on 8403 patients who underwent IPAA with a median post-procedure follow-up of 6.3 years (interquartile range [IQR], 3.9-8.2 years), the authors estimate a pooled prevalence of cancer of the pouch of 0.5% (ie, 1 in 200 patients with IPAA may develop pouch cancer any time after colectomy).…”

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confidence: 99%

“…Second, the estimated prevalence of cancer after colectomy is 6.4 times higher after procedures in which the rectum was left intact (IRA or rectal stump surgery) as compared with total proctocolectomy with IPAA. 7 Although this finding is intuitive, with cancer risk being proportional to the amount of colorectal tissue at risk, it needs to be translated into action with routine surveillance of these high-risk patients. This particularly applies to patients with end-ileostomy with intact rectal stump; these are patients who need to be informed of the cancer risk (2%), and physicians need to remain aware of patients' surgical anatomy after colectomy to enable appropriate surveillance for early detection.…”

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confidence: 99%

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No Cancer Without a Colon? Think Again! Colorectal Cancer Risk After Colectomy for Inflammatory Bowel Diseases

Singh

Loftus

2016

Clinical Gastroenterology and Hepatology

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Surveillance pouchoscopy for dysplasia: Cleveland Clinic Ileoanal Pouch Anastomosis Database

Lightner

Vaidya

Vogler

et al. 2020

British Journal of Surgery

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Background: No formal guidelines exist for surveillance pouchoscopy following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis. Methods: All adults who had previously had IPAA for ulcerative colitis, and underwent a pouchoscopy between 1 January 2010 and 1 January 2020, were included. Results: A total of 9398 pouchoscopy procedures were performed in 3672 patients. The majority of the examinations were diagnostic (8082, 86⋅0 per cent; 3260 patients) and the remainder were for routine surveillance (1316, 14⋅0 per cent; 412 patients). Thirteen patients (0⋅14 per cent of procedures) were found to have biopsy-proven neoplasia at the time of pouchoscopy; seven had low-grade dysplasia (LGD) (0⋅07 per cent; all located in the anal transition zone), none had high-grade dysplasia (HGD) and six (0⋅06 per cent) had invasive adenocarcinoma (4 in anal transition zone and 6 in pouch). Of the six patients with adenocarcinoma, four had neoplasia at the time of proctocolectomy (2 adenocarcinoma, 1 LGD, 1 HGD); all six were symptomatic with anal bleeding or pelvic pain at the time of pouchoscopy, had a negative surveillance pouchoscopy examination within 2 years of diagnosis of adenocarcinoma, had palpable masses on digital rectal examination, and had visible lesions at the time of pouchoscopy. Conclusion: Surveillance pouchoscopy is not recommended in asymptomatic patients because significant neoplasia following IPAA for ulcerative colitis is rare.

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Risk of Neoplasia After Colectomy in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Cited by 75 publications

References 84 publications

Colorectal Cancer in Inflammatory Bowel Disease

Colorectal Cancer in Inflammatory Bowel Disease

No Cancer Without a Colon? Think Again! Colorectal Cancer Risk After Colectomy for Inflammatory Bowel Diseases

Surveillance pouchoscopy for dysplasia: Cleveland Clinic Ileoanal Pouch Anastomosis Database

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