Lauricella Sara, Fabris Silvia, Sylla Patricia
Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai Hospital, 5 E 98th St 14th Fl, Ste D, New York, NY, 10029, USA.
Surg Endosc. 2023 Jan;37(1):48-61. doi: 10.1007/s00464-022-09462-w. Epub 2022 Aug 3.
To date, the optimal management of patients with inflammatory bowel disease (IBD) and flat low-grade dysplasia (fLGD) of the colon or rectum remains controversial.
A systematic review was reported in accordance with PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Patients diagnosed with fLGD on surveillance endoscopy were pooled from studies published between 2000 and 2020. Advanced neoplasia was defined by the presence of HGD, CRC or small bowel adenocarcinoma detected on subsequent surveillance endoscopy or from examination of resection specimens. We estimated the pooled annual incidence rate of colorectal cancer (CRC) and advanced neoplasia, and the risk factors associated with neoplastic progression.
We identified 24 articles and 738 IBD patients were diagnosed with fLGD on endoscopy. Two hundred thirty-six patients (32%) underwent immediate surgery with surgical specimens demonstrating CRC in 8 patients (pooled prevalence, 8.66%; 95% CI 3.58-19.46) and HGD (high grade dysplasia) in 11 patients (pooled prevalence, 13.97%; 95% CI 5.65-30.65). Five hundred-two patients (68%) underwent endoscopic surveillance with 63 patients with fLGD progressing to advanced neoplasia during endoscopic surveillance (38 HGD, 24 CRC and one patient developing small bowel adenocarcinoma). The mean duration of follow-up after fLGD diagnosis was 71 months (10.9-212). The pooled incidence of CRC and advanced neoplasia was 0.5 (95% CI 0.23-0.77) and 1.71 per 100 patient-year (95% CI 0.88-2.54) respectively. The use of corticosteroids and location of fLGD in the distal colon were significantly associated with neoplastic progression.
This study provides a summary incidence rate of CRC and advanced neoplasia in patients with IBD and fLGD to inform surgeons' and endoscopists' decision-making thus reducing potential ineffective treatments.
迄今为止，炎症性肠病（IBD）合并结肠或直肠扁平低级别异型增生（fLGD）患者的最佳管理仍存在争议。
按照PRISMA 2020（系统评价和Meta分析的首选报告项目）报告了一项系统评价。从2000年至2020年发表的研究中汇总了在监测内镜检查中诊断为fLGD的患者。高级别瘤变定义为在随后的监测内镜检查中或切除标本检查中发现的高级别异型增生（HGD）、结直肠癌（CRC）或小肠腺癌。我们估计了结直肠癌（CRC）和高级别瘤变的合并年发病率，以及与肿瘤进展相关的危险因素。
我们纳入了24篇文章，738例IBD患者在内镜检查中诊断为fLGD。236例患者（32%）接受了即刻手术，手术标本显示8例患者患有CRC（合并患病率，8.66%；95%可信区间3.58 - 19.46），11例患者患有HGD（高级别异型增生）（合并患病率，13.97%；95%可信区间5.65 - 30.65）。502例患者（68%）接受了内镜监测，63例fLGD患者在监测期间进展为高级别瘤变（38例HGD，24例CRC，1例患者发生小肠腺癌）。fLGD诊断后的平均随访时间为71个月（10.9 - 212）。CRC和高级别瘤变的合并发病率分别为每100患者年0.5（95%可信区间0.23 - 0.77）和1.71（95%可信区间0.88 - 2.54）。使用皮质类固醇和fLGD位于结肠远端与肿瘤进展显著相关。
本研究提供了IBD合并fLGD患者中CRC和高级别瘤变的汇总发病率，为外科医生和内镜医生的决策提供依据，从而减少潜在的无效治疗。
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