Roel Bogie

Endoscopic subtypes of colorectal laterally spreading tumors and risk of submucosal invasion: A meta-analysis

Study quality The risk of outcome bias was low in all included studies. The risk of population bias was high in four population based studies and in 20 lesion-based studies ( Table 3.2 ). Table 3.3 summarizes the definition of LSTs in the included studies. Prevalence Seven studies reported the total number of patients included (136,896 patients) and the number of patients with one or more LSTs. Five of these included all consecutive patients undergoing colonoscopy, 19, 26, 31, 37, 39 while two studies included only patients undergoing screening colonoscopy. 29, 36 The pooled prevalence of patients with one ore more LSTs of all patients was 0.8% (95% CI: 0.6 – 1.1%, I 2 : 92.4%, Figure 3.4a ). The pooled prevalence of patients with one or more LSTs among patients with neoplasms was 3.0% (95% Cl: 2.3 – 3.7, I 2 : 93.9%, Figure 3.4b ). The pooled prevalence of LSTs among all neoplasms was 3.6% (95%CI: 2.5 – 4.9, I 2 : 96.9, Figure 3.4c ). Geographic region and starting year of inclusion had no significant effect on LST prevalence. The funnel plots of these analyses are shown in Figure 3.5 . Heterogeneity and Funnel plot asymmetry were significant ( P <0.001) in all three analyses.

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Table 3.3: Laterally spreading tumor definition used in the included studies.

# Definition

Based on (publication) Kudo 2008 1 / Kudo 1993 81

Studies

1

Katano 2017, 44 Burgess 2017, 17 Yamada 2016, 9 Kudo 2015, 45 Zhao 2014, 26 Togashi 2014, 46 Miyamoto 2014, 47 Konda 2014, 48 Yoon 2013, 49 Urban 2013, 50 Kim 2013, 30 Kakugawa 2013, 51 Nakae 2012, 53 Kim 2012, 54 Kim 2011, 32 Kaku 2011, 33 Kaji 2011, 55 Sugimoto 2010, 56 Matsuda 2010, 34 Oka 2009, 57 Huang 2009, 58 Chiu 2009, 36 Urban 2008, 59 Nosho 2008, 60 Kudo 2008, 1 Uraoka 2006, 62 Katsinelos 2006, 63 Hiraoka 2006, 64 Su 2005, 65 Tanaka 2001, 67 Saito 2001, 68 Teixeira 1996 69

“A neoplasm with predominantly lateral growth of at least 10 mm in diameter; this is in opposition to polypoid (upward growth) or flat and depressed lesions (downward growth).”

2

Dos Santos 2014, 28 Rotondano 2011, 19 Tantau 2008 37

“Large non-polypoid lesion <2.5mm in height (height:width ratio <1:3 for LST-G-NM)” “Non-polypoid lesion ≥10mm in size”

Paris classification 2003 82

3

Xiang 2014, 27 Reinhart 2013, 29 Kaltenbach 2007, 61 Parra-Blanco 2006, 39 O’Brien 2004, 40 Kim 2003, 66 Tsuda 2002, 41 Rembacken 2000, 42 Jaramillo 1995 43

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4

Sawada 1989 83

Bustamente-Balen 2010 35

“Non-polypoid lesions >10mm with height:width ratio <1:2”

5

Terasaki 2012, 52 Martinez 2012 31

No definition

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51