Background and Aims
Methods
Results
Conclusions
Abbreviations:
CD (Crohn’s disease), CI (confidence interval), CRC (colorectal cancer), ESD (endoscopic submucosal dissection), HGD (high-grade dysplasia), IBD (inflammatory bowel disease), LGD (low-grade dysplasia), PI (prediction interval), UC (ulcerative colitis)Methods
Search strategy
Study selection
Data abstraction
Subgroup analyses and meta-regression analyses
Assessment methodology and definitions
Statistical analysis
Results
Search results and population characteristics
- Buchner A.M.
- Mahmud N.
- Elhanafi S.
- et al.
- Buchner A.M.
- Mahmud N.
- Elhanafi S.
- et al.
Characteristics and quality of included studies
- Buchner A.M.
- Mahmud N.
- Elhanafi S.
- et al.
- Buchner A.M.
- Mahmud N.
- Elhanafi S.
- et al.
Meta-analysis outcomes
- Buchner A.M.
- Mahmud N.
- Elhanafi S.
- et al.



Pooled rate (95% confidence interval, I2) Pooled rate per 1000 person-years of follow-up | Heterogeneity (95% prediction interval, I2) | |
---|---|---|
Pooled risk of colorectal cancer | 2 (0-3)/1000 person-years; 17 studies | 1.2-4.2; 0 |
Pooled risk of high-grade dysplasia | 2 (1-3)/1000 person-years; 17 studies | 1-7; 0 |
Pooled risk of any lesion | 43 (30-57)/1000 person-years; 18 studies | 1-63; 88 |
Pooled rate of patients requiring surgery | 9.9% (6.5-14.7); 18 studies | 2-40; 80 |
Pooled rate of bleeding | 2.2% (1.1-4.4); 13 studies | 1-14; 47 |
Pooled rate of perforation | 2% (.9-4.4); 13 studies | 1-17; 50 |
Publication bias (Egger’s 2-tailed P value) | .01 |
Subgroup and meta-regression analysis
Subgroup analysis based on IBD type (UC only and UC + CD)
CRC (incidence per 1000 person-years of follow-up) | HGD (incidence per 1000 person-years of follow-up) | Any lesion (incidence per 1000 person-years of follow-up) | |
---|---|---|---|
UC only vs UC + CD | 2 (0-3); 11 studies | 2 (0-3); 11 studies | 35 (20-51); 12 studies |
2 (0-5); 5 studies; P = .72 | 2 (0-4); 5 studies; P = .95 | 50 (25-75); 5 studies; P = .08 | |
Sample size: <50, >50 | 10 (1-20); 7 studies | 12 (2-22); 7 studies | 50 (23-77); 7 studies |
2 (0-3); 10 studies; P = .07 | 2 (0-3); 10 studies; P = .04 | 41 (26-56); P = .57 |
Subgroup analysis based on sample size (<50 and >50)
Meta-regression analysis
Variable | Random effects, Knapp-Hartung, 2-sided P value (CRC, HGD, any lesion) |
---|---|
IBD type: UC only | .77, .89 |
IBD type: UC + CD | .96, .74 |
Paris type I | .35, .45, .89 |
Paris type II | .79, .6, .18 |
EMR | .41, .37, .54 |
ESD | .95, .58, .45 |
Polypectomy | .34, .65, .89 |
En bloc removal | .2, .4, .3 |
Piecemeal removal | .5, .1, .6 |
Right-sided lesion | .28, .18, .44 |
Left-sided lesion | .07, .24, .18 |
Lesion size | .06, .46, .97 |
LGD | .06, .1, .16 |
HGD | .09, .6, .05 |
Validation of meta-analysis results
Sensitivity analysis
Heterogeneity
Publication bias
Quality of evidence
Discussion
Acknowledgment
Appendix









Study | Selection | Comparability | Outcome | Score | Quality | |||||
---|---|---|---|---|---|---|---|---|---|---|
Representativeness of the average adult in community Population based: 1; multicenter: .5; single center: 0 | Cohort size >40 patients: 1; 39 to 20: 0.5; <20: 0 | Information on clinical outcomes Information with clarity: 1; information derived from percentage value: .5; unclear: 0 | Outcome not present at start Not present: 1; present: 0 | Factors comparable between the groups Yes: 1; no: 0 | Adequate clinical assessment Yes: 1; no: 0 | Follow-up time Yes: 1; not mentioned: 0 | Adequacy of follow-up All patients followed up: 1; >50% followed up: 0.5; <50% followed up or not mentioned: 0 | Maximum = 8 | High >6, medium 4-6, low <4 | |
Al-Kandari, 2019 | .5 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 7 | High |
Branquinho, 2016 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Buchner, 2019 | 0 | .5 | 1 | 1 | 1 | 1 | 1 | .5 | 6 | Medium |
Choi, 2014 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Gulati, 2018 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | .5 | 5.5 | Medium |
Hurlstone, 2007 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Ignjatovic, 2011 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | .5 | 5.5 | Medium |
Kaltenbach, 2019 | .5 | .5 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Kinoshita, 2018 | .5 | .5 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Kisiel, 2011 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Odze, 2004 | .5 | .5 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Quinn, 2013 | .5 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 7 | High |
Rubin, 1999 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Saoula, 2017 | 0 | .5 | 1 | 1 | 1 | 1 | 1 | .5 | 6 | Medium |
Smith, 2008 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Suzuki, 2017 | .5 | .5 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Vieth, 2006 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
Yadav, 2019 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | .5 | 6.5 | High |
- Supplementary Table 1
Appendix 1
Literature search strategy: data sources and search strategies
# | Searches | Results |
---|---|---|
1 | Endoscopic Mucosal Resection/ | 7237 |
2 | (endoscop∗ adj2 resect∗).ti. | 8878 |
3 | 1 or 2 | 13,850 |
4 | (colon∗ or colorect∗ or colitis or colectom∗).ti. | 588,426 |
5 | exp Colon/ | 144,733 |
6 | 4 or 5 | 655,035 |
7 | 3 and 6 | 2902 |
8 | Colonic Polyps/ and (surg∗ or resect∗).ti,ab,hw,kw,kf. | 3915 |
9 | exp ∗Colon/ and (surg∗ or resect∗).ti,ab,hw,kw,kf. | 15,115 |
10 | exp ∗Colon/su | 8321 |
11 | Colonic Polyps/su or colon polyp/su | 4888 |
12 | or/8-11 | 23,199 |
13 | endoscop∗.ti. | 214,186 |
14 | exp Endoscopy, Digestive System/ or exp digestive tract endoscopy/ | 312,140 |
15 | 13 or 14 | 450,911 |
16 | 12 and 15 | 6257 |
17 | 7 or 16 | 8594 |
18 | exp Inflammatory Bowel Diseases/ | 220,418 |
19 | ("inflammatory bowel disease∗" or "ulcerative colitis" or crohn∗).ti,ab,hw,kw,kf. | 282,028 |
20 | 18 or 19 | 286,468 |
21 | 17 and 20 | 579 |
22 | 3 and 20 | 237 |
23 | 21 or 22 | 679 |
24 | (pediatric∗ or children).ti. | 1,404,030 |
25 | 23 not 24 | 659 |
26 | limit 25 to english language [Limit not valid in CDSR; records were retained] | 611 |
27 | 26 not ((exp animals/ or exp nonhuman/) not exp humans/) | 610 |
28 | 27 not ((case∗ adj3 (report∗ or stud∗)).ti,ab,hw,kw. or case report/ or exp case study/) | 470 |
29 | remove duplicates from 28 | 415 |
1 | TITLE-ABS-KEY ( ( endoscop∗ W/2 resect∗ ) AND ( "inflammatory bowel disease∗" OR "ulcerative colitis" OR crohn∗ ) ) |
2 | INDEX(embase) OR INDEX(medline) OR PMID(0∗ OR 1∗ OR 2∗ OR 3∗ OR 4∗ OR 5∗ OR 6∗ OR 7∗ OR 8∗ OR 9∗) |
3 | #1 and not #2 |
Item no. | Recommendation | Reported on page no. |
---|---|---|
Reporting of background should include | ||
1 | Problem definition | 4 |
2 | Hypothesis statement | -na- |
3 | Description of study outcome(s) | 6-7 |
4 | Type of exposure or intervention used | 6-7 |
5 | Type of study designs used | 6-7 |
6 | Study population | 6 |
Reporting of search strategy should include | ||
7 | Qualifications of searchers (eg, librarians and investigators) | 6, Appendix 1 |
8 | Search strategy, including time period included in the synthesis and key words | 6, Appendix 1 |
9 | Effort to include all available studies, including contact with authors | 7 |
10 | Databases and registries searched | Appendix 1 |
11 | Search software used, name and version, including special features used (eg, explosion) | NA |
12 | Use of hand searching (eg, reference lists of obtained articles) | 6 |
13 | List of citations located and those excluded, including justification | Supplementary Figure 1 |
14 | Method of addressing articles published in languages other than English | 6 |
15 | Method of handling abstracts and unpublished studies | 6 |
16 | Description of any contact with authors | 7 |
Reporting of methods should include | ||
17 | Description of relevance or appropriateness of studies assembled for assessing the hypothesis to be tested | 6-8 |
18 | Rationale for the selection and coding of data (eg, sound clinical principles or convenience) | 6-8 |
19 | Documentation of how data were classified and coded (eg, multiple raters, blinding and interrater reliability) | 6-8 |
20 | Assessment of confounding (eg, comparability of cases and control subjects in studies where appropriate) | 7 |
21 | Assessment of study quality, including blinding of quality assessors, stratification or regression on possible predictors of study results | 7 |
22 | Assessment of heterogeneity | 8 |
23 | Description of statistical methods (eg, complete description of fixed or random-effects models, justification of whether the chosen models account for predictors of study results, dose–response models, or cumulative meta-analysis) in sufficient detail to be replicated | 8 |
24 | Provision of appropriate tables and graphics | Provided |
Reporting of results should include | ||
25 | Graphic summarizing individual study estimates and overall estimate | Figure 1, Figure 2, Figure 3 Supplementary Figure 2, Supplementary Figure 3, Supplementary Figure 4 |
26 | Table giving descriptive information for each study included | Supplementary Table 1 |
27 | Results of sensitivity testing (eg, subgroup analysis) | NA |
28 | Indication of statistical uncertainty of findings | 10-11 |
Reporting of discussion should include | ||
29 | Quantitative assessment of bias (eg, publication bias) | 11 |
30 | Justification for exclusion (eg, exclusion of non-English language citations) | 6 |
31 | Assessment of quality of included studies | Supplementary Table 2 |
Reporting of conclusions should include | ||
32 | Consideration of alternative explanations for observed results | 12-14 |
33 | Generalization of the conclusions (ie, appropriate for the data presented and within the domain of the literature review) | 12-14 |
34 | Guidelines for future research | 14 |
35 | Disclosure of funding source | 2 |
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Article info
Publication history
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: B. Shen: Consultant for Abbvie and Takeda. M. Iacucci: Research support from NIHR Biomedical Research Centre, Birmingham, UK. U. Navaneethan: Consultant for Takeda, Abbvie, Janssen, and Pfizer. All other authors disclosed no financial relationships.
If you would like to chat with an author of this article, you may contact Dr Mohan at [email protected]