A Greater Proportion of Liver Transplant Candidates Have Colorectal Neoplasia Than in the Healthy Screening Population

• Published in: Clinical gastroenterology and hepatology Vol. 13; no. 5; pp. 956 - 962
• Main Authors: Jeschek, Philip, Ferlitsch, Arnulf, Salzl, Petra, Heinze, Georg, Györi, Georg, Reinhart, Karoline, Waldmann, Elisabeth, Britto-Arias, Martha, Trauner, Michael, Ferlitsch, Monika
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2015
• Subjects: Adenoma - epidemiology; Cohort Studies; Colon Cancer; Colonoscopy; Colorectal Neoplasms - epidemiology; Early Detection; Female; Gastroenterology and Hepatology; Humans; Liver Cirrhosis - complications; Male; Middle Aged; Prevalence; Retrospective Studies; Screening Colonoscopy; RR; NAFLD; polyp detection rate; ADR; ALCI; Early Detection; nonalcoholic steatohepatitis; Colon Cancer; OLT; Screening Colonoscopy; orthotopic liver transplantation; BMI; PDR; advanced adenoma detection rate; colorectal cancer; body mass index; CI; NASH; relative risk; AADR; adenoma detection rate; alcoholic cirrhosis; nonalcoholic fatty liver disease; CRC; confidence interval
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2014.08.018

Background & Aims Various types of liver disease are associated with an increased prevalence of colorectal adenomas. We investigated whether cirrhosis is a risk factor for colorectal neoplasia by analyzing colonoscopy findings from 2 cohorts of patients awaiting liver transplantation. Methods We performed a retrospective analysis to compare findings from colorectal cancer screenings of 567 adult patients with cirrhosis placed on the waitlist for liver transplantation with those from controls (matched for age, sex, body mass index, smoking, and diabetes). Rates of adenoma and advanced adenoma detection were adjusted owing to differences in rates of polypectomies performed in the 2 cohorts. Results Adenomas were detected in a significantly higher percentage of patients with cirrhosis (29.3%) than in controls (21.5%) ( P  = .0057; relative risk [RR], 1.36; 95% confidence interval [CI], 1.09–1.69); and patients with cirrhosis had a higher rate of advanced adenoma detection than controls (13.9% vs 7.7%; P  = .0015; relative risk, 1.82; 95% CI, 1.25–2.64). A greater percentage of patients with alcoholic cirrhosis had neoplasias (34.3%) than controls (25.3%; P  = .0350; RR, 1.36), and rates of advanced adenoma detection were 16.7% vs 10.2% ( P  = .0409; RR, 1.63). Adenomas were detected in 27.8% of patients with viral cirrhosis vs 15.9% of controls ( P  = .0061; RR, 1.74), with rates of advanced adenoma detection of 13.6% vs 5.0% ( P  = .0041; RR, 2.73). Similar proportions of patients with cirrhosis of other etiologies and controls were found to have colorectal neoplasias. Conclusions Based on a retrospective analysis of colonoscopy findings from patients awaiting liver transplantation, those with alcoholic or viral cirrhosis are at higher risk of developing colorectal neoplasia and should be considered for earlier colonoscopy examination.