Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 966-984
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.966
Patients with inflammatory bowel disease and post-inflammatory polyps have an increased risk of colorectal neoplasia: A meta-analysis
Jia-ling Shi, Ye-hong Lv, Jun Huang, Xue Huang, Ying Liu
Jia-ling Shi, Ye-hong Lv, Jun Huang, Xue Huang, Ying Liu, Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
Author contributions: Shi JL and Huang X designed the research; Shi JL, Lv YH and Huang J performed the research; Huang J and Shi JL contributed analytic tools; Lv YH, Huang J, Huang X and Liu Y analyzed the data; Shi JL wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81660093.
Conflict-of-interest statement: The authors deny any conflict of interest.
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: Xue Huang, PhD, Professor, Department of Geriatrics and Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Province, China. hb960305@163.com
Received: August 30, 2021
Peer-review started: August 30, 2021
First decision: October 27, 2021
Revised: November 5, 2021
Accepted: December 23, 2021
Article in press: December 23, 2021
Published online: January 21, 2022
Processing time: 137 Days and 21.6 Hours
Abstract
BACKGROUND

Longstanding intestinal inflammation increases the risk of colorectal neoplasia in patients with inflammatory bowel disease (IBD). Accurately predicting the risk of colorectal neoplasia in the early stage is still challenging. Therefore, identifying visible warning markers of colorectal neoplasia in IBD patients is the focus of the current research. Post-inflammatory polyps (PIPs) are visible markers of severe inflammation under endoscopy. To date, there is controversy regarding the necessity of strengthened surveillance strategies for IBD patients with PIPs.

AIM

To determine whether IBD patients with PIPs carryan increased risk of colorectal neoplasia.

METHODS

Researchers searched the following databases up to July 31, 2021: MEDLINE (PubMed), MEDLINE (Ovid), EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wan-Fang Data, China Science and Technology Journal Database and Chinese BioMedical Literature Database. Cohort and case-control studies that compared the risk of colorectal neoplasia between IBD patients with or without PIPs and published in English or Chinese were included. Methodological quality was assessed using the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool. The outcomes of interest were the rates of various grades of colorectal neoplasia. The pooled risk ratio (RR) and 95% confidence interval (95%CI) were calculated using the random-effects model. Begg’s test and Egger’s test were used to calculate the publication bias. Sensitivity and subgroup analyses were performed to verify the robustness of the results. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess the overall quality of evidence supporting the outcomes of interest.

RESULTS

Nine studies involving 5424 IBD patients (1944 with PIPs vs 3480 without PIPs) were included. The overall bias in each included study ranged from moderate to serious. Compared with nonconcurrent PIPs, patients with PIPs had a higher risk of colorectal neoplasia (RR = 1.74, 95%CI: 1.35-2.24, P < 0.001, I2 = 81.4%; aHR = 1.31, 95%CI: 1.01-1.70, P = 0.04, I2 = 26.2%; aOR = 2.62, 95%CI: 1.77-3.88, P < 0.001, I2 = 0%), advanced colorectal neoplasia (RR = 2.07, 95%CI: 1.49-2.87, P < 0.001, I2 = 77.4%; aHR = 1.63, 95%CI: 1.05-2.53, P = 0.03, I2 = 10.1%) and colorectal cancer (RR = 1.93, 95%CI: 1.32-2.82, P = 0.001, I2 = 83.0%). Publication bias was not observed in Begg’s test or Egger’s test. Sensitivity and subgroup analyses showed that the results are robust. The overall quality of evidence was assessed as moderate to low.

CONCLUSION

IBD patients with PIPs may have an increased incidence of colorectal neoplasia.

Keywords: Inflammatory bowel disease; Ulcerative colitis; Pseudopolyps; Inflammatory polyps; Colorectal cancer; Colorectal neoplasia

Core Tip: This study is the first systematic review and meta-analysis to separately evaluate the potential risk between post-inflammatory polyps (PIPs) and colorectal neoplasia, advanced colorectal neoplasia, and colorectal cancer. Interestingly, we found that although malignant transformation from PIPs is rare, inflammatory bowel disease (IBD) patients with PIPs still bear an increased incidence of various grades of colorectal neoplasia. As an early warning of the increasing risk of colorectal neoplasia, IBD patients with PIPs should undergo strengthened surveillance to detect early dysplastic changes to allow for appropriate management so that there are improvements in both quality of life and survival rates.