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.

中文翻译：

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内镜切除炎性肠病患者结肠不典型增生：系统评价和荟萃分析。

背景和目标

炎症性肠病（IBD）是大肠癌（CRC）的众所周知的危险因素。当前指南建议对IBD患者进行完整的内镜下不典型增生切除，并进行密切的内镜随访。目前关于IBD患者内镜切除异型增生后肿瘤形成的风险的数据有限。

方法

从开始到2019年8月，检索了多个数据库，以鉴定报告IBD异型增生切除后肿瘤形成和/或复发的研究。将纳入研究的结果汇总起来，以评估IBD患者异型增生切除后瘤形成的风险。

结果

从18项研究中，对1037名IBD患者进行了内窥镜切除术，总共有1428例结肠病变。病灶切除后，CRC的合并风险（每1000人年的发生率）为2（95％置信区间[CI]，0-3），高度不典型增生的合并风险为2（95％） CI为1-3），任何病变的合并风险为43（95％CI为30-57）。基于病变位置（右，左），病变大小（平均和/或中位大小，以mm为单位），病变类型（巴黎I型，巴黎II型），内窥镜切除技术（EMR，内窥镜黏膜下剥离术或息肉切除术）和病变组织学检查（低度不典型增生，高度不典型增生）均未影响已报道的结局。

结论

IBD患者不典型增生切除后发生CRC的风险似乎较低，这支持了目前的切除和监测策略。