Post written by Yuga Komaki and Atsushi Sakuraba from the Section of Gastroenterology, Hepatology, and Nutrition at The University of Chicago Medicine.

We performed a systematic review and meta-analysis to assess the risk of colorectal cancer in various chronic liver diseases compared to the general population. We also assessed whether the risk would change with liver transplantation.

Colorectal cancer is one of the leading causes of death throughout the world. Certain populations of patients such as those with ulcerative colitis, primary sclerosing cholangitis, Lynch syndrome, etc, are at higher risk for colorectal cancer and have different recommendations regarding surveillance intervals. However, there is no specific recommendation regarding patients with chronic liver diseases. Life expectancy of patients with chronic liver diseases is improving, and it is extremely important to reduce the risk of any other complication including colorectal cancer.

Our meta-analysis demonstrated that patients with hepatitis and cirrhosis had a two-fold increased risk of colorectal cancer. Our analysis utilizing meta-regression showed that, similar to the general population, advanced age was correlated with the risk of colorectal cancer in patients with hepatitis and cirrhosis. We showed a pooled standardized incidence rate of 6.70 among primary sclerosing cholangitis patients, and our present meta-analysis is the first to show the increased risk in primary sclerosing cholangitis compared to the general population. We also assessed the risk of colorectal cancer in post-liver transplant patients and demonstrated that they carried a similarly elevated risk of colorectal cancer compared to non-transplanted patients. We showed a correlation between the proportion of autoimmune related liver diseases and the risk of colorectal cancer, and this suggested that there was still increased risk when assuming a study contained no patients with autoimmune liver disease.

Figure 1. Flowchart of the assessment of the studies identified in the meta-analysis.

Our findings suggest that patients with chronic liver diseases need a more intensive screening/surveillance schedule for colorectal cancer compared to the general population. Moreover, those after liver transplant are similarly at risk for colorectal cancer and still need an intensive screening/surveillance schedule for colorectal cancer. Our study will have a great impact on clinical practice and management of patients with chronic liver diseases, and we expect that it will be cited in guidelines for liver diseases.

Find the article abstract here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.