Original Articles
Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: A meta-analysis,☆☆

https://doi.org/10.1067/mge.2002.125367Get rights and content

Abstract

Background: Published data on the risk of colorectal neoplasia in patients with ulcerative colitis with and without primary sclerosing cholangitis are conflicting. A meta-analysis was performed to synthesize available publications and to compare the risk of colorectal neoplasia in patients with ulcerative colitis with and without primary sclerosing cholangitis. Methods: By using MEDLINE and manual search methods, studies were identified that compared the risk of colorectal neoplasia (dysplasia and carcinoma) in patients with ulcerative colitis with and without primary sclerosing cholangitis. In addition, citations were reviewed in relevant articles and proceedings from gastroenterology meetings, and investigators were contacted when data were incomplete. The summary odds ratio (OR) was then calculated for the risk for patients with ulcerative colitis and primary sclerosing cholangitis of having colorectal neoplasia develop compared with that of patients with ulcerative colitis without primary sclerosing cholangitis. Results: Eleven studies met all eligibility criteria for the meta-analysis. Patients with ulcerative colitis and primary sclerosing cholangitis are at increased risk of colorectal dysplasia and carcinoma compared with patients with ulcerative colitis alone; OR 4.79: 95% CI [3.58, 6.41] with the Mantel-Haenszel method, and OR 5.11: 95% CI [3.15, 8.29] with the Der Simonian and Laird method. This increased risk is present even when the risk of colorectal carcinoma alone is considered; OR 4.09: 95% CI [2.89, 5.76] and OR 4.26: 95% CI [2.80, 6.48] by using, respectively, the Mantel-Haenszel and the Der Simonian and Laird methods. Conclusions: Patients with ulcerative colitis and primary sclerosing cholangitis have a significantly higher risk for the development of colorectal neoplasia than patients with ulcerative colitis but not primary sclerosing cholangitis. More intensive colonoscopic surveillance should be considered for patients with ulcerative colitis and primary sclerosing cholangitis. (Gastrointest Endosc 2002;56:48-54.)

Section snippets

Data identification and selection

Three investigators (R.M.S., O.S.L., P.A.N.) independently searched the MEDLINE database for citations for January 1985 to December 2001 by using the keywords inflammatory bowel disease, ulcerative colitis, and sclerosing cholangitis. In addition, a manual search was performed with the citations in relevant articles and the proceedings from meetings of the American Gastroenterological Association, the American College of Gastroenterology, and the American Association for the Study of Liver

Study selection

Computer-based and manual bibliographic searches identified 22 pertinent articles.1, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 Eleven articles that contained 12 studies met the inclusion criteria.1, 4, 5, 6, 7, 8, 9, 10, 11, 13, 23 Eight studies were published as full articles in peer-reviewed journals,1, 5, 6, 7, 8, 9, 10, 23 2 were published in abstract form,4, 11 and 2 studies were published in a single letter to the editor13 in response to the original

Discussion

The present meta-analysis indicates an approximate 4-fold increased risk for CR neoplasia in patients with UC and PSC, compared with those with UC alone. This increased risk does not change appreciably when the presence or absence of carcinoma is the only outcome considered. The inclusion of only high-quality studies is one of the important determinants of the validity of a meta-analysis. In the present synthesis, studies reported in abstract form and as letters to the editor were included

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  • Cited by (0)

    Supported in part by an American Digestive Health Foundation Outcomes Research Training Award to Dr. Soetikno.

    ☆☆

    Reprint requests: Roy M. Soetikno, MD, Gastroenterology Section (111-GI), Palo Alto Veterans Affairs Health Care System, 1801 Miranda Ave., Palo Alto, CA 94304.

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