MICROBIOTA-TARGETED THERAPIES FOR PREVENTION OF COLORECTAL ADENOMA RECURRENCE AFTER POLYPECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Date
2026-05-12
Authors
Layan Elayan
Mohammed Amer Kamel
Shankar Biswas
Yashasvi Srivastava
Ayman Hamadttu
Journal Title
Journal ISSN
Volume Title
Publisher
Deanship of Scientific Research - Al-Quds University
Abstract
Background: Colorectal cancer is the third most common malignancy worldwide, with approximately 1.9 million new cases annually. Despite effective removal of premalignant lesions, colorectal adenoma recurrence remains a major clinical challenge, affecting up to 60% of patients within five years after polypectomy. Current chemopreventive strategies are limited by modest efficacy or safety concerns. Aspirin benefits only a narrow population, while NSAIDs and nutritional supplements have shown no consistent benefit. Emerging evidence implicates gut microbiota dysbiosis in colorectal carcinogenesis, providing a strong biological rationale for microbiota-targeted interventions.
Objectives: To conduct a systematic review and meta-analysis pooling probiotics, prebiotics, and microbiome-modulating agents under a unified framework to estimate their collective and class-specific efficacy in preventing colorectal adenoma recurrence following polypectomy, and to assess the certainty of evidence.
Methods: This systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD420251247058). PubMed, Embase, CENTRAL, and Web of Science were searched from inception through November 2025 for randomized controlled trials evaluating microbiota-targeted therapies versus placebo or no treatment in adults post-polypectomy. The primary outcome was adenoma recurrence at surveillance colonoscopy. Risk ratios (RR) were pooled using random-effects models. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was evaluated using GRADE.