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Clinics and Research in Hepatology and Gastroenterology
Volume 43, n° 2
pages 201-207 (avril 2019)
Doi : 10.1016/j.clinre.2018.03.001
Digestive diseases

Risk of metachronous advanced lesions after resection of diminutive and small, non-advanced adenomas
 

Ido Laish a, b, , Ilia Sergeev a, b, Assaf Stein a, b, Timna Naftali a, b, Fred M. Konikoff a, b
a Gastroenterology and Hepatology Institute, Meir Medical Center, Kfar Saba, Israel 
b Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel 

Corresponding author at: Gastroenterology and Hepatology Institute, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel.Gastroenterology and Hepatology Institute, Meir Medical Center59 Tchernichovsky St.Kfar Saba 44281Israel
Highlights

Among patients who underwent polypectomy of up to two non-advanced adenomas, the risk of metachronous advanced lesion was the same between those with diminutive (1–5 mm) and small (6–9 mm) polyps at baseline.
This risk was significantly higher than those with no polyps at baseline.
Among background demographics and clinical variables at baseline colonoscopy, fair preparation was the only independent risk factor that was associated with metachronous advanced lesions.
These findings support uniform recommendations for surveillance colonoscopy for these lesions.

The full text of this article is available in PDF format.
Summary
Background and aims

Current post-polypectomy surveillance interval guidelines do not discriminate between 1–2 diminutive (1–5mm) and small (6–9mm) non-advanced adenomas. This study compared the risk for metachronous advanced lesions in these groups.

Methods

Patients with 1–2 diminutive, non-advanced adenomas and no further advanced lesions, and patients with no polyps at baseline colonoscopy were retrospectively analyzed to determine the rate of metachronous advanced lesions. These were defined as the combined rate of colon cancer, advanced adenoma and ≥ 3 non-advanced adenomas at surveillance colonoscopy. Polyp size was measured either subjectively by the endoscopist or by pathology-based measurements.

Results

Among patients with diminutive (n  = 395) and small polyps (n  = 110), advanced lesions were found in 68 patients (17.2%) and 16 patients (14.5%), respectively (P  = 0.53), during a mean follow-up of 4.3 ± 0.9 years. In contrast, advanced lesions were observed in 33 patients (6.6%) in the no polyp group (n  = 505), significantly lower than diminutive (P  = 0.000) and small polyp groups (P  = 0.002), despite a mean follow-up duration of 6.1 ± 1.9 years. The rate of metachronous advanced lesions was also similar between patients with 1–3mm polyps (16%) versus 7–9mm polyps (15.8%).

Conclusions

Our findings suggest that among patients who underwent polypectomy of up to 2 non-advanced adenomas, those with diminutive and small polyps have the same risk of metachronous advanced lesions; thus, supporting uniform recommendations for surveillance colonoscopy for these lesions.

The full text of this article is available in PDF format.

Keywords : Diminutive, Adenomas, Metachronous advanced lesions

Abbreviations : CRC, TA, LGD, NAA, OR




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