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Endoscopic resection for non-polypoid dysplasia in inflammatory bowel disease: a systematic review and meta-analysis

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Abstract

Background

This systematic review and meta-analysis aims to evaluate efficacy and safety of endoscopic treatment for the non-polypoid dysplasia in patients with long-standing IBD.

Methods

Medline, Embase, Cochrane, and clinicaltrials.gov registry were comprehensively searched. Pooled estimates of curative, R0, en-bloc resection rates, CRC, metachronous dysplasia, and local recurrence rates were calculated. Subgroup analysis according to areas, lesion size, endoscopic resection techniques, and grades of dysplasia were conducted. Data synthesis was completed in R using the package “meta”.

Results

Of the 973 studies initially identified, 7 met the inclusion/exclusion criteria. These were all single-arm cohorts and included a total of 202 patients with IBD and non-polypoid dysplasia. The combined R0 and en-bloc resection rate were 0.70 (95% CI 0.55–0.81) and 0.86 (95% CI 0.65–0.95), respectively, with a recurrence rate of 0.08 (95% CI 0.05–0.13). CRC and metachronous dysplasia incidences were pooled as 32.53 (95% CI 12.21–86.67) and 90.24 (95% CI 44.91–181.33) per 1000 patient years.

Conclusions

Non-polypoid dysplasia associated with IBD can be resected endoscopically, especially by ESD. However, these patients have higher CRC and metachronous dysplasia incidence rates than patients with polypoid dysplasia, indicating a closer endoscopic surveillance.

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Acknowledgements

The authors would like to thank Dr. Yang Chen and Dr. Wen Shi (Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College) for providing critical comments for the overall design and manuscript.

Funding

This study was supported by a grant from CAMS Innovation Fund for Medical Sciences (CIFMS; No. 2016‑I2M‑1‑002) and a grant from Peking Union Medical College (2019zlgc0133, 2019zlgc0503).

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Author notes

  1. Wei Chen and Yue-Lun Zhang contributed equally and should be regarded as co-first authors.

Authors and Affiliations

  1. Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Wei Chen, Yi Zhao, Ai-Ming Yang, Jia-Ming Qian & Dong Wu

  2. Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Yue-Lun Zhang

  3. State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Dong Wu

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  1. Wei Chen
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Contributions

CW contributed to the concept and design of the study, screening of studies, collection and interpretation of data, and drafting of article. ZYL contributed to the design of searching strategy, collection and interpretation of data, and critical revision of the study methods. ZY contributed to the screening of studies and critical revision of the article for important intellectual content. YAM and QJM made critical revision of the article for important intellectual content. WD contributed to the concept and design of the study, and critical revision of the article for important intellectual content. All authors approved the final version of the article, including the authorship list.

Corresponding author

Correspondence to Dong Wu.

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Disclosures

Wei Chen, Yue-Lun Zhang, Yi Zhao, Ai-Ming Yang, Jia-Ming Qian, and Dong Wu have no conflicts of interest or financial ties to disclose.

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Chen, W., Zhang, YL., Zhao, Y. et al. Endoscopic resection for non-polypoid dysplasia in inflammatory bowel disease: a systematic review and meta-analysis. Surg Endosc 35, 1534–1543 (2021). https://doi.org/10.1007/s00464-020-08225-9

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