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Risk of Developing Metachronous Advanced Colorectal Neoplasia After Polypectomy in Patients With Multiple Diminutive or Small Adenomas.
Am J Gastroenterol. 2019 10; 114(10):1657-1664.AJ

Abstract

INTRODUCTION

Current post-polypectomy guidelines recommend a 3-year surveillance interval for ≥3 nonadvanced adenomas (NAAs) without discrimination between diminutive (1-5 mm) and small (6-9 mm) adenomas. We compared the risk of metachronous advanced colorectal neoplasia (ACRN) among these groups.

METHODS

We studied 9,733 patients who underwent ≥1 adenoma removal and follow-up colonoscopic surveillance. Patients were classified based on baseline adenoma characteristics: group 1, 1-2 NAAs (n = 8,051); group 2, ≥3 diminutive NAAs (n = 293); group 3, ≥3 small NAAs (n = 258); and group 4, advanced adenomas (AAs) (n = 1,131).

RESULTS

The mean age of the study population was 45.8 ± 8.2 years. In group 4, most patients (94.5%) had 1 AA. The 3- and 5-year cumulative incidence rates of metachronous ACRN in groups 1, 2, 3, and 4 were 0.9%, 2.8%, 3.5%, and 4.0% and 3.1%, 10.7%, 15.1%, and 8.5%, respectively. Groups 2, 3, and 4 had a higher risk of metachronous ACRN than group 1. Compared with those for group 1, adjusted hazard ratios (95% confidence interval) for metachronous ACRN were 2.07 (1.16-3.68), 3.29 (1.94-5.56), and 2.73 (2.00-3.72) for groups 2, 3, and 4, respectively. However, this relationship was statistically insignificant between groups 2, 3, and 4. Compared with those for group 2, adjusted hazard ratios (95% confidence intervals) for groups 3 and 4 were 1.59 (0.76-3.30) and 1.32 (0.72-2.42), respectively, and 0.83 (0.47-1.46) for group 4 compared with group 3. The results of patients aged ≥50 years were identical to those of all patients.

DISCUSSION

Risk of metachronous ACRN was not different between patients aged ≥50 years who underwent polypectomy of ≥3 diminutive NAAs, ≥3 small NAAs, and AA, thus supporting current guidelines that recommend a uniform surveillance interval for these lesions.

Authors+Show Affiliations

Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31211708

Citation

Kim, Nam Hee, et al. "Risk of Developing Metachronous Advanced Colorectal Neoplasia After Polypectomy in Patients With Multiple Diminutive or Small Adenomas." The American Journal of Gastroenterology, vol. 114, no. 10, 2019, pp. 1657-1664.
Kim NH, Jung YS, Lee MY, et al. Risk of Developing Metachronous Advanced Colorectal Neoplasia After Polypectomy in Patients With Multiple Diminutive or Small Adenomas. Am J Gastroenterol. 2019;114(10):1657-1664.
Kim, N. H., Jung, Y. S., Lee, M. Y., Park, J. H., Park, D. I., & Sohn, C. I. (2019). Risk of Developing Metachronous Advanced Colorectal Neoplasia After Polypectomy in Patients With Multiple Diminutive or Small Adenomas. The American Journal of Gastroenterology, 114(10), 1657-1664. https://doi.org/10.14309/ajg.0000000000000296
Kim NH, et al. Risk of Developing Metachronous Advanced Colorectal Neoplasia After Polypectomy in Patients With Multiple Diminutive or Small Adenomas. Am J Gastroenterol. 2019;114(10):1657-1664. PubMed PMID: 31211708.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of Developing Metachronous Advanced Colorectal Neoplasia After Polypectomy in Patients With Multiple Diminutive or Small Adenomas. AU - Kim,Nam Hee, AU - Jung,Yoon Suk, AU - Lee,Mi Yeon, AU - Park,Jung Ho, AU - Park,Dong Il, AU - Sohn,Chong Il, PY - 2019/6/19/pubmed PY - 2020/4/9/medline PY - 2019/6/19/entrez SP - 1657 EP - 1664 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 114 IS - 10 N2 - INTRODUCTION: Current post-polypectomy guidelines recommend a 3-year surveillance interval for ≥3 nonadvanced adenomas (NAAs) without discrimination between diminutive (1-5 mm) and small (6-9 mm) adenomas. We compared the risk of metachronous advanced colorectal neoplasia (ACRN) among these groups. METHODS: We studied 9,733 patients who underwent ≥1 adenoma removal and follow-up colonoscopic surveillance. Patients were classified based on baseline adenoma characteristics: group 1, 1-2 NAAs (n = 8,051); group 2, ≥3 diminutive NAAs (n = 293); group 3, ≥3 small NAAs (n = 258); and group 4, advanced adenomas (AAs) (n = 1,131). RESULTS: The mean age of the study population was 45.8 ± 8.2 years. In group 4, most patients (94.5%) had 1 AA. The 3- and 5-year cumulative incidence rates of metachronous ACRN in groups 1, 2, 3, and 4 were 0.9%, 2.8%, 3.5%, and 4.0% and 3.1%, 10.7%, 15.1%, and 8.5%, respectively. Groups 2, 3, and 4 had a higher risk of metachronous ACRN than group 1. Compared with those for group 1, adjusted hazard ratios (95% confidence interval) for metachronous ACRN were 2.07 (1.16-3.68), 3.29 (1.94-5.56), and 2.73 (2.00-3.72) for groups 2, 3, and 4, respectively. However, this relationship was statistically insignificant between groups 2, 3, and 4. Compared with those for group 2, adjusted hazard ratios (95% confidence intervals) for groups 3 and 4 were 1.59 (0.76-3.30) and 1.32 (0.72-2.42), respectively, and 0.83 (0.47-1.46) for group 4 compared with group 3. The results of patients aged ≥50 years were identical to those of all patients. DISCUSSION: Risk of metachronous ACRN was not different between patients aged ≥50 years who underwent polypectomy of ≥3 diminutive NAAs, ≥3 small NAAs, and AA, thus supporting current guidelines that recommend a uniform surveillance interval for these lesions. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/31211708/Risk_of_Developing_Metachronous_Advanced_Colorectal_Neoplasia_After_Polypectomy_in_Patients_With_Multiple_Diminutive_or_Small_Adenomas_ L2 - https://Insights.ovid.com/pubmed?pmid=31211708 DB - PRIME DP - Unbound Medicine ER -