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. 2023 Sep 30;15(19):4820.
doi: 10.3390/cancers15194820.

The Risk of Colorectal Polyps after Weight Loss Therapy Versus Obesity: A Propensity-Matched Nationwide Cohort Study

Hisham Hussan  1 , Eric McLaughlin  2 , Chienwei Chiang  2 , Joseph G Marsano  1 , David Lieberman  3
Affiliations

The Risk of Colorectal Polyps after Weight Loss Therapy Versus Obesity: A Propensity-Matched Nationwide Cohort Study

Hisham Hussan et al. Cancers (Basel). .

Abstract

Background: A fundamental understanding of the impact of bariatric surgery (BRS) on mechanisms of colorectal carcinogenesis is limited. For instance, studies report a reduced risk of colorectal cancer in females but not in males after BRS. We examined whether this sex-specific difference existed at the earlier polyp development stage.

Methods: This retrospective cohort study included 281,417 adults from the 2012-2020 MarketScan database. We compared polyps rates on colonoscopy in four groups: post- vs. pre-BRS (treatment) to post- vs. pre-severe obesity (SO) diagnosis (control). We focused our main analysis on a propensity-matched sample that yielded a balanced distribution of covariates in our four groups (n = 9680 adults, 21.9% males). We also adjusted for important covariates.

Results: Metabolic syndrome parameters improved after bariatric surgery and worsened after severe obesity diagnosis (p < 0.05). The rate of polyps was 46.7% at a median of 0.5 years pre-BRS and 47.9% at a median of 0.6 years pre-SO diagnosis. The polyps rate was 45.4% at a median (range) of 3.2 (1.0-8.5) years post-BRS. Conversely, 53.8% of adults had polyps at 3.0 (1.0-8.6) years post-SO. There was no change in the risk of colorectal polyps in males or females post- vs. pre-BRS. However, the risk of polyps was higher in males (OR = 1.32, 95% CI: 1.02-1.70) and females (OR = 1.29, 95% CI: 1.13-1.47) post- vs. pre-SO. When compared to the control group (SO), the odds ratios for colorectal polyps were lower for males and females after bariatric surgery (OR = 0.63, 95% CI: 0.44-0.90, and OR = 0.79, 95% CI: 0.66-0.96, respectively).

Conclusions: Obesity is associated with an increased risk of colorectal polyps, an effect that is ameliorated after bariatric surgery. These data are relevant for studies investigating colorectal carcinogenesis mechanisms.

Keywords: bariatric surgery; colorectal cancer; gastric bypass; risk factor; sleeve gastrectomy.

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Conflict of interest statement

The authors have no relevant conflict of interest, including relevant financial interests, activities, relationships, or affiliations.

Figures

Figure 1
Figure 1
Study schema. * Index visit is earliest documentation of severe obesity for controls or date of bariatric surgery for cases.
Figure 2
Figure 2
The propensity-matched analysis. Colorectal polyp rates by group and sex. BRS: Bariatric Surgery; SO: Severe Obesity.
See this image and copyright information in PMC

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