77 Malignancy Incidence in the Residual Rectum of Ibd Patients After Colectomy: Systematic Review and Meta-Analysis

Abstract

Abstract Aim The primary objective of this study is to estimate the incidence of rectal carcinoma in patients with an Inflammatory Bowel Disease diagnosis, who have had a total colectomy preserving the rectum. The secondary objectives are to identify the risk factors associated with malignancy occurrence and to explore the current recommendations for screening processes for these patients. Method A systematic review in 5 databases was conducted to identify studies adhering to the PICO criteria. The included studies were critically appraised, and the relevant data was extracted. Malignancy incidence was estimated from the reported information and risk stratification was analysed using RevMan. A narrative approach was undertaken for the exploration of the existing screening guidelines. Results A total of 24 studies were included. The pooled incidence of rectal carcinoma across 23 studies was calculated to be 1.3%. Subgroup analysis showed an incidence of 0.7% and 3.2% for patients with a rectal stump and ileo-rectal anastomosis respectively. Patients with a history of a colorectal carcinoma were more likely to have a subsequent diagnosis of rectal carcinoma (RR 7.2), similarly to patients with a history of colorectal dysplasia (RR 5.1). Ten studies reported frequent surveillance using endoscopy and rectal biopsies. No studies recommending screening guidelines for the target population could be identified. Conclusions The overall risk for malignancy incidence was estimated to be 1.3% which is lower than previously quoted. Due to the paucity of good quality of literature in this field, it is not possible to suggest further guidance for this cohort of patients at present.