Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2022; 14(1): 348-361
Published online Jan 15, 2022. doi: 10.4251/wjgo.v14.i1.348
Increased risk of colorectal neoplasia in inflammatory bowel disease patients with post-inflammatory polyps: A systematic review and meta-analysis
De-Gao He, Xi-Jie Chen, Juan-Ni Huang, Jun-Guo Chen, Min-Yi Lv, Tian-Ze Huang, Ping Lan, Xiao-Sheng He
De-Gao He, Xi-Jie Chen, Jun-Guo Chen, Min-Yi Lv, Tian-Ze Huang, Ping Lan, Xiao-Sheng He, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655, Guangdong Province, China
Juan-Ni Huang, Department of Geriatrics, the first Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
Author contributions: He DG, Chen XJ and Huang JN contributed equally to this work; He DG, Chen XJ and He XS designed study; He DG, Chen XJ, performed literature search and review, He DG, Chen XJ, Huang JN, Chen JG, Lv MY and Huang TZ collected data; He DG, Chen XJ, Huang JN and He XS wrote and edited the manuscript; He DG and Lan P did statistical analysis; He DG, Chen XJ, Huang JN, Chen JG, Lv MY and Huang TZ contributed to methodological quality assessment; Lan P and He XS reviewed manuscript; All authors have read and approved the final manuscript.
Supported by The National Key R&D Program of China, No. 2017YFC1308800; National Natural Science Foundation of China, No. 81970482; Natural Science Foundation of Guangdong Province, China, No. 2019A1515011313; Sun Yat-Sen University 5010 Project, No. 2010012; and the Fundamental Research Funds for the Central Universities, No. 19ykpy05, and National Key Clinical Discipline.
Conflict-of-interest statement: Authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Sheng He, MD, PhD, Doctor, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, No. 26 Yuancun Er Heng Road, Guangzhou 510655, Guangdong Province, China. hexsheng@mail.sysu.edu.cn
Received: August 6, 2021
Peer-review started: August 6, 2021
First decision: August 29, 2021
Revised: September 8, 2021
Accepted: November 24, 2021
Article in press: November 24, 2021
Published online: January 15, 2022
Processing time: 157 Days and 6.3 Hours
Abstract
BACKGROUND

Inflammatory bowel disease (IBD) patients with post-inflammatory polyps (PIPs) may carry an increased risk of colorectal neoplasia (CRN) including dysplasia and cancer. Current guidelines recommend active colonoscopy follow-up for these patients. However, the evidence for guidelines is still poor. In addition, some recent high-quality reports present a different view, which challenges the current guidelines. We hypothesize that IBD patients with PIPs are at increased risk of CRN.

AIM

To evaluate the risk of CRN in IBD patients with and without PIPs.

METHODS

A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was performed to identify studies that compared the risk of CRN in IBD patients with and without PIPs. In addition, we screened the reference lists and citation indices of the included studies. Quality assessment was performed using the Newcastle–Ottawa Scale. Pooled odds ratio (OR) was calculated using the random-effects model to explore the final pooled effect size of the included studies and determine whether PIPs increase the risk of CRN. Sensitivity analysis, subgroup analysis, and assessment of publication bias were performed to examine the sources of heterogeneity.

RESULTS

Twelve studies with 5819 IBD patients, including 1281 (22.01%) with PIPs, were considered eligible for this meta-analysis. We found that IBD patients with PIPs were at an increased risk of CRN as compared to those without PIPs [OR 2.01; 95% confidence interval (CI): 1.43–2.83]. The results were similar when colorectal cancer was used as the study endpoint (OR 2.57; 95%CI: 1.69–3.91). Furthermore, the risk of CRN was still increased (OR 1.80; 95%CI: 1.12–2.91) when restricted to ulcerative colitis patients. Heterogeneity was high among the included studies (I² = 75%). Subgroup analysis revealed that the high heterogeneity was due to the study design. Sensitivity analysis showed that the main statistical outcomes did not essentially change after excluding any one of the included studies. No significant publication bias was found in the funnel plots.

CONCLUSION

IBD patients with PIPs have an increased risk of CRN as compared with those without PIPs, which support the current guidelines. However, a high-quality randomized controlled trial is warranted.

Keywords: Colorectal neoplasia; Inflammatory bowel disease; Ulcerative colitis; Post-inflammatory polyps; Pseudopolyps; Meta-analysis

Core Tip: Inflammatory bowel disease (IBD) patients with post-inflammatory polyps (PIPs) may carry an increased risk of colorectal neoplasia (CRN). Current guidelines recommend active colonoscopy follow-up for these patients. However, the evidence is still poor. We found that IBD patients with PIPs have a higher risk of CRN than those without PIPs. The results were similar when colorectal cancer was used as the endpoint of the study. Our findings not only confirm the viewpoint of the guidelines, but may also improve the degree of evidence. We expect that our study will provide a reference for the development of surveillance strategies for IBD patients.