Endoscopic resection of colon dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis

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 a total of 18 studies, 1037 IBD patients underwent endoscopic resection for a total of 1428 colonic lesions. After lesion resection, the pooled risk (in rate per 1000 person years of follow-up) of CRC was 2 (95% confidence interval [CI], 0-3), the pooled risk of HGD 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-I, Paris-II), endoscopic resection technique (endoscopic mucosal resection, endoscopic submucosal dissection, or polypectomy), and lesion histology (low-grade dysplasia, high-grade dysplasia) did not influence the reported outcomes. Conclusion Risk of CRC after dysplasia resection in IBD patients appears to be low, supporting the current strategy of resection and surveillance.