Dr Scarpa and colleagues assessed the prevalence and site of dysplasia after restorative proctocolectomy for ulcerative colitis.
The research team identified risk factors that could be used in a surveillance programme.
The team searched medical databases for potentially relevant publications between 1978 and 2006.
|Prevalence of high-grade dysplasia was 0.2|
|British Journal of Surgery|
Studies that dealt with restorative proctocolectomy for ulcerative colitis, and postoperative surveillance were included.
There were 2 researchers who independently performed study selection, quality assessment, data extraction, and analysis.
The researchers included 23 observational studies and case series, with a total of 2040 patients.
The pooled prevalence of confirmed dysplasia in the pouch, anal transitional zone or rectal cuff was about 1%.
The prevalence of high-grade dysplasia, low-grade dysplasia and indefinite for dysplasia was 0.2%, 1%, and 1.2%, respectively.
The researchers found that dysplasia was equally frequent in the pouch and rectal cuff or anal transitional zone.
Dysplasia and cancer identified before or at operation seemed to be significant predictors of the development of dysplasia.
The research team observed that pouchitis and duration of follow-up were not of predictive value.
Dr Scarpa's team concluded, “Although based on low-level evidence from uncontrolled studies, the prevalence of dysplasia observed after restorative proctocolectomy was remarkable.”
“A surveillance programme that takes into account the risk factors found is therefore advocated.”