Abstract
Goals
To analyze our experience with adenoma detection rates in patients with liver cirrhosis in a community setting.
Background
Colorectal cancer (CRC) is the third most common cancer and leading cause of cancer death in men and women in the USA. The majority of CRCs arise from premalignant polyps (adenomas), which are typically detected and removed during colonoscopy. Data are limited on the risk of CRC in patients with various chronic liver diseases and the association between CRC and demographics, liver disease etiology and colonoscopy findings.
Study Results
A total of 351 colonoscopies were performed (2006 to 2019) in patients with liver cirrhosis. Mean age was 62.3 ± 9.4 years, there were 158 females and 193 males. Adenomas were found in 159 procedures (49.07%) and were more likely found in the right colon (76.73%) vs the left colon (18.87%). Left-sided adenoma occurrence was significantly lower in women (61% lower than men, p = 0.05). Neither indication for the procedure (p = 0.08) nor advancing age (p = 0.94) affected adenoma detection rates. No significant differences were observed in the findings of adenomas between different chronic liver diseases.
Conclusions
Adenoma detection rates in patients with cirrhosis (49%) undergoing elective colonoscopy were higher than rates reported in the literature for LT candidates (22–42%) undergoing standardized screenings. Colonoscopy screenings should be expanded to all patients with cirrhosis, regardless of etiology.
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References
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69:7–34.
Lichtenstein P, Holm NV, Verkasalo PK et al. Environmental and heritable factors in the causation of cancer–analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med 2000;343:78–85.
Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell 1990;61:759–767.
Dawwas MF. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:2539–2540.
American Cancer Society Guideline for Colorectal Cancer Screening. Available at: https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html. Accessed March 31, 2021.
Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012;366:687–696.
Selingo JA, Herrine SK, Weinberg DS et al. Role of screening colonoscopy in elective liver transplantation evaluation. Transplant Proc. 1997;29:2506–2508.
Prenner S, Levitsky J. Comprehensive Review on Colorectal Cancer and Transplant. Am J Transplant. 2017;17:2761–2774.
Jeschek P, Ferlitsch A, Salzl P et al. A greater pro- portion of liver transplant candidates have colorectal neoplasia than in the healthy screening population. Clin Gastroenterol Hepatol 2015;13:956–962.
Bhatt BD, Lukose T, Siegel AB et al. Increased risk of colorectal polyps in patients with nonalcoholic fatty liver disease undergoing liver transplant evaluation. J Gastrointest Oncol 2015;6:459–468.
Ishikawa S, Kato J, Kuriyama M et al. Feasibility and findings of colonoscopy for living-donor liver transplant candidates. J Clin Gastroenterol 2009;43:69–74.
Troschel AS, Miks, A Troschel FM, et al. Chronic liver disease promotes lesions of the colorectal adenoma-carcinoma sequence, independent of liver cirrhosis. United European Gastroenterology Journal 2019;7:662–72.
Naveau S, Chaput JC, Bedossa P et al. Cirrhosis as an independent risk factor for colonic adenomas. Gut 1992;33:535–540.
Fedirko V, Tramacere I, Bagnardi V et al. Alcohol drinking and colorectal cancer risk: an overall and dose-response meta- analysis of published studies. Ann Oncol 2011;22:1958–1972.
World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, DC: AICR, 2007. Available at: https://www.wcrf.org/dietandcancer. Accessed April 1, 2021.
American Liver Foundation. Available at: https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/nonalcoholic-steatohepatitis-information-center/nash-definition-prevalence/. Accessed April 12, 2021.
Stadlmayr A, Aigner E, Steger B et al. Nonalcoholic fatty liver disease: an independent risk factor for colorectal neoplasia. J Intern Med 2011;270:41–49.
Wong VW-S, Wong GL-H, Tsang SW-C, et al. High prevalence of colorectal neoplasm in patients with nonalcoholic steato- hepatitis. Gut. 2011;60:829–836.
Paterson AC, Leeding KS, Bach LA et al. More about: prospective study of colorectal cancer risk in men and plasma levels of insulin-like growth factor (IGF)-I and IGF- binding protein-3. J Natl Cancer Inst 2000;92:1947–1950.
Agrawal RP, Sheroan V, Ola V et al. Hepatocyte growth factor, adiponectin and hepatic histopathology in non- alcoholic steatohepatitis. J Assoc Physicians India 2013;61:789–792.
Turer AT, Browning JD, Ayers CR et al. Adiponectin as an independent predictor of the presence and degree of hepatic steatosis in the Dallas Heart Study. J Clin Endocrinol Metab 2012;97:E982–E986.
Kumor A, Daniel P, Pietruczuk M et al. Serum leptin, adiponectin, and resistin concentration in colorectal adenoma and carcinoma (CC) patients. Int J Colorectal Dis 2009;24:275–281.
Schnabl B, Brenner DA. Interactions between the intestinal microbiome and liver diseases. Gastroenterology 2014;146:1513–1524.
Qin N, Yang F, Li A et al. Alterations of the human gut microbiome in liver cirrhosis. Nature 2014;513:59–64.
Irrazábal T, Belcheva A, Girardin SE et al. The multifaceted role of the intestinal microbiota in colon cancer. Mol Cell 2014;54:309–320.
US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325:1965–1977.
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Kugelmas, M., Zapata, I., Tawil, J. et al. Liver Cirrhosis Increases the Risk of Developing Advanced Colon Polyps. Dig Dis Sci 68, 931–938 (2023). https://doi.org/10.1007/s10620-022-07561-1
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DOI: https://doi.org/10.1007/s10620-022-07561-1