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
ARTICLE HIGHLIGHTS
Research 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 IBD patients in the early stage is still challenging. Post-inflammatory polyps (PIPs) are visible markers of severe inflammation under endoscopy. To date, there is controversy in the literature regarding the necessity of a strengthened surveillance strategy for IBD patients with PIPs.

Research motivation

Unnecessary and frequent endoscopic surveillance not only decreases the quality of life of IBD patients but also increases the burdens of health care and resource stewardship. Therefore, it is crucial to explore the potential risk association between PIPs and colorectal neoplasia. A better insight into this topic would help physicians to clarify the safe and reasonable endoscopic surveillance intervals for IBD patients with PIPs.

Research objectives

To determine whether IBD patients with PIPs bear an increased risk of various grades of colorectal neoplasia.

Research methods

Researchers systematically searched eight databases up to July 31, 2021. 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 (ROBINS-I) 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 (GRADE) approach was used to assess the overall quality of evidence supporting the outcomes of interest.

Research results

Of 792 records, four cohort studies and five case-control studies involving 5424 IBD patients (1944 with PIPs vs 3480 without PIPs) were included in this study. The overall bias in each included study ranged from moderate to serious. After meta-analyses, IBD patients with PIPs were significantly associated with a higher risk of colorectal neoplasia than IBD patients without PIPs (RR = 1.74, 95%CI: 1.35-2.24, P < 0.001, I2 = 81.4%). Meanwhile, patients with PIPs also had a higher risk of advanced colorectal neoplasia (RR = 2.07, 95%CI: 1.49-2.87, P < 0.001, I2 = 77.4%) and colorectal cancer (RR = 1.93, 95%CI: 1.32-2.82, P = 0.001, I2 = 83.0%). Publication bias was not observed. And Sensitivity and subgroup analyses showed that the results are robust. The overall quality of evidence was assessed as moderate to low.

Research conclusions

IBD patients with PIPs may have an increased incidence of various grades of colorectal neoplasia. Due to the lower rate of malignant transformation, PIPs do not need to be removed conventionally. However, due to the increased risk of colorectal neoplasia, IBD patients with PIPs should undergo strengthened surveillance to detect early dysplastic changes to allow for appropriate management to improve quality of life and survival rates.

Research perspectives

There are still many gaps in this field of research, such as information on safe and reasonable endoscopic surveillance intervals for patients with PIPs and the pathogenic process of PIPs in colorectal neoplasia. Therefore, additional well-designed multicenter trials are needed.