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Systematic review with meta-analysis: the incidence of advanced neoplasia after polypectomy in patients with and without low-risk adenomas.
Aliment Pharmacol Ther. 2014 May; 39(9):905-12.AP

Abstract

BACKGROUND

Patients with one to two tubular adenomas <1 cm in size without high-grade dysplasia (low-risk group) are considered at low risk for colorectal cancer. However, it is uncertain whether they have the same risk of subsequent advanced neoplasia as those with no neoplasia at baseline colonoscopy.

AIM

To compare incidence of metachronous advanced neoplasia between patients in the low-risk adenoma group and those without neoplasia at index colonoscopy.

METHODS

Relevant publications were identified by MEDLINE/EMBASE and other databases for the period 1992-2013. Studies comparing the incidence of post-polypectomy advanced neoplasia (adenomas ≥10 mm/high-grade dysplasia/villous or cancer) between the low-risk group and patients without colorectal neoplasia at the first colonoscopy were included. Detection rates for advanced neoplasia at endoscopic surveillance were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random-effect models. Inter-study heterogeneity was assessed using the I(2) statistic.

RESULTS

Seven studies provided data on 11 387 patients. Mean surveillance periods ranged between 2 and 5 years. Altogether, 267 patients with post-polypectomy advanced neoplasia were detected in the two groups. The incidence of advanced neoplasia was 1.6% (119/7308) in those without neoplasia and 3.6% (148/4079) in those with low-risk adenoma, respectively, corresponding to a relative risk of 1.8 (95% CI: 1.3-2.6). Inter-study heterogeneity was only moderate (I(2) : 37%). No publication bias was present.

CONCLUSIONS

Patients with low-risk adenomas at baseline had a higher risk of metachronous advanced neoplasia than the group with no adenomas at baseline, though the absolute risk was low in both groups.

Authors+Show Affiliations

Digestive Endoscopy Unit, Catholic University, Rome, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

24593121

Citation

Hassan, C, et al. "Systematic Review With Meta-analysis: the Incidence of Advanced Neoplasia After Polypectomy in Patients With and Without Low-risk Adenomas." Alimentary Pharmacology & Therapeutics, vol. 39, no. 9, 2014, pp. 905-12.
Hassan C, Gimeno-García A, Kalager M, et al. Systematic review with meta-analysis: the incidence of advanced neoplasia after polypectomy in patients with and without low-risk adenomas. Aliment Pharmacol Ther. 2014;39(9):905-12.
Hassan, C., Gimeno-García, A., Kalager, M., Spada, C., Zullo, A., Costamagna, G., Senore, C., Rex, D. K., & Quintero, E. (2014). Systematic review with meta-analysis: the incidence of advanced neoplasia after polypectomy in patients with and without low-risk adenomas. Alimentary Pharmacology & Therapeutics, 39(9), 905-12. https://doi.org/10.1111/apt.12682
Hassan C, et al. Systematic Review With Meta-analysis: the Incidence of Advanced Neoplasia After Polypectomy in Patients With and Without Low-risk Adenomas. Aliment Pharmacol Ther. 2014;39(9):905-12. PubMed PMID: 24593121.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic review with meta-analysis: the incidence of advanced neoplasia after polypectomy in patients with and without low-risk adenomas. AU - Hassan,C, AU - Gimeno-García,A, AU - Kalager,M, AU - Spada,C, AU - Zullo,A, AU - Costamagna,G, AU - Senore,C, AU - Rex,D K, AU - Quintero,E, Y1 - 2014/03/04/ PY - 2013/12/06/received PY - 2013/12/28/revised PY - 2014/02/11/revised PY - 2014/02/11/accepted PY - 2014/3/6/entrez PY - 2014/3/7/pubmed PY - 2014/10/21/medline SP - 905 EP - 12 JF - Alimentary pharmacology & therapeutics JO - Aliment Pharmacol Ther VL - 39 IS - 9 N2 - BACKGROUND: Patients with one to two tubular adenomas <1 cm in size without high-grade dysplasia (low-risk group) are considered at low risk for colorectal cancer. However, it is uncertain whether they have the same risk of subsequent advanced neoplasia as those with no neoplasia at baseline colonoscopy. AIM: To compare incidence of metachronous advanced neoplasia between patients in the low-risk adenoma group and those without neoplasia at index colonoscopy. METHODS: Relevant publications were identified by MEDLINE/EMBASE and other databases for the period 1992-2013. Studies comparing the incidence of post-polypectomy advanced neoplasia (adenomas ≥10 mm/high-grade dysplasia/villous or cancer) between the low-risk group and patients without colorectal neoplasia at the first colonoscopy were included. Detection rates for advanced neoplasia at endoscopic surveillance were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random-effect models. Inter-study heterogeneity was assessed using the I(2) statistic. RESULTS: Seven studies provided data on 11 387 patients. Mean surveillance periods ranged between 2 and 5 years. Altogether, 267 patients with post-polypectomy advanced neoplasia were detected in the two groups. The incidence of advanced neoplasia was 1.6% (119/7308) in those without neoplasia and 3.6% (148/4079) in those with low-risk adenoma, respectively, corresponding to a relative risk of 1.8 (95% CI: 1.3-2.6). Inter-study heterogeneity was only moderate (I(2) : 37%). No publication bias was present. CONCLUSIONS: Patients with low-risk adenomas at baseline had a higher risk of metachronous advanced neoplasia than the group with no adenomas at baseline, though the absolute risk was low in both groups. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/24593121/Systematic_review_with_meta_analysis:_the_incidence_of_advanced_neoplasia_after_polypectomy_in_patients_with_and_without_low_risk_adenomas_ L2 - https://doi.org/10.1111/apt.12682 DB - PRIME DP - Unbound Medicine ER -