Increased risk of colorectal neoplasia in inflammatory bowel disease patients with post-inflammatory polyps: A systematic review and meta-analysis

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 ( I ² = 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.

Post-inflammatory Polyp Burden as a Prognostic Marker of Disease-outcome in Patients with Inflammatory Bowel Disease

“…IBD patients with PIPs were at an increased risk of CRC as compared to those without (Odds Ratio [OR] 2.01; 95% confidence interval [CI] 1.43-2.83). 5 However, large studies within the meta-analysis revealed a higher risk of colectomy and hospitalisation but not CRC. 3,4 Dysplasia and CRC are possible complications of IBD and increase both morbidity and mortality associated with IBD.…”

Sonographic detection of massive colonic pseudopolyposis in inflammatory bowel diseases

“…Post-inflammatory polyps are defined endoscopically as cicatricial, digitiform protrusions of the mucosa that result from re-epithelization and excessive regeneration of ulcerated colonic mucosa [ 1 ]. They are often multiple and are more frequently found in the left colon [ 3 ].…”

“…Post-inflammatory polyps are a marker of previous episodes of severe inflammatory activity and several studies have shown an association with an increased risk of colorectal cancer, resulting in the need for shortened surveillance intervals [ 3 , 4 ]. However, a recent study reported an association between post-inflammatory polyps and increased risk of disease severity, more extensive colonic disease as well as higher rates of colectomy but not with an increased risk of colorectal cancer [ 5 ].…”

Frequency and Predictors of Dysplasia in Pseudopolyp-like Colorectal Lesions in Patients with Long-Standing Inflammatory Bowel Disease

“…A possible explanation of the link between pseudopolyps and the risk of CRC lies in the fact that they represent an indirect marker of previous episodes of severe colonic inflammation and their incidence rises with the extent of colitis. It is also plausible that the presence of pseudopolyps, especially when they are very numerous, may make it more difficult for the operator to detect dysplastic lesions while performing surveillance colonoscopy [ 10 , 14 , 15 ].…”