Cancer Risk After Polyp Resection in Chronic Ulcerative Colitis

Douglas K. Rex, MD

Results support current guideline recommendations for complete endoscopic resection with follow-up.

The management of polypoid dysplasia in patients with chronic ulcerative colitis has moved toward endoscopic excision and continued surveillance when the morphology of polypoid lesions allows for endoscopic resection. The current meta-analysis assessed the risk for colorectal cancer development after endoscopic resection of polyps in patients with ulcerative colitis.

From 425 articles and one Cochrane review, the authors selected 10 studies with 376 patients with inflammatory bowel disease and resected polypoid dysplasia with subsequent follow-up. Patients underwent an average of 2.8 colonoscopies during a mean surveillance period of 54.4 months. Nine cancers were observed, for a pooled incidence of 5.3 cancers per 1000 years. None of the studies reported use of chromoendoscopy, but all reported whether patients had flat dysplasia in the surrounding mucosa.

By comparison, in a 2007 meta-analysis of colorectal cancer risk after identification of flat dysplasia, incidence was 14 per 1000 years of patient follow-up.

Citation(s):

Wanders LK et al. Cancer risk after resection of polypoid dysplasia in patients with longstanding ulcerative colitis: A meta-analysis. Clin Gastroenterol Hepatol 2014 May; 12:756.