S3272 Prevalence of Colonic Adenomas in Cirrhotic Patients Undergoing Pre-Transplant Evaluation: A Meta-Analysis and Systematic Review

Abstract

INTRODUCTION: Multiple studies have suggested that the risk of advanced adenomas and colorectal cancer is not only higher in liver transplant patients, but also significantly increases post transplantation, particularly due to their immunocompromised state. As it stands, CRC screening recommendations in low to moderate risk liver transplant candidates are the same for those of the general population. This study aims to analyze the literature on the prevalence of adenomas in liver cirrhosis patients undergoing colonoscopy screening as part of their pre-transplant evaluation. METHODS: A systemic review was conducted in PUBMED, Embase, PubMed Central and ScienceDirect databases from inception through May 2020. Effect estimates from the individual studies were extracted and combined using the random effect, generic inverse variance method of DerSimonian and Laird and pooled event rates were calculated. Forest plots were generated, and publication bias was assessed for using conventional techniques. RESULTS: Eleven studies with a total of 4223 patients with cirrhosis undergoing liver transplant evaluation were included in this analysis. The pooled event rate for any adenoma was 21.2% (95% CI, 16.9%–26.2%), whereas the pooled event rate for advanced adenoma was 5.6% (95% CI, 2.7%–11.4%). The pooled event rate for adenocarcinoma was 0.7% (95% CI, 0.03%–1.7%), most of which were successfully resected endoscopically. CONCLUSION: This study suggests a considerable prevalence of adenomatous polyps and advanced lesions in this high-risk patient population, and hence, colonoscopy should be performed for every transplant candidate within the frame of the current ACG recommendations. Additionally, our results call for further risk-matched prospective studies to examine the need for earlier endoscopic surveillance in this cohort of patients.Figure 1.: Forrest plot, pooled event rate of any adenoma in cirrhotic patients undergoing transplant evaluation.Figure 2.: Forrest plot, pooled event rate of advanced adenomas in cirrhotic patients undergoing transplant evaluation.Figure 3.: Forrest plot, pooled event rate of adenocarcinoma in cirrhotic patients undergoing transplant evaluation.