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The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia.
Gastrointest Endosc. 2020 03; 91(3):614-621.e6.GE

Abstract

BACKGROUND AND AIMS

Patients with previous colorectal adenomas are at increased risk of colorectal cancer. Current guidelines for postpolypectomy surveillance intervals treat all tubular adenomas 1 to 9 mm in size with low-grade dysplasia as carrying the same level of risk. We evaluated whether 6 to 9 mm adenomas detected at colonoscopy are associated with greater risk of advanced neoplasia at follow-up compared with baseline 1 to 5 mm adenomas.

METHODS

We retrospectively evaluated a colonoscopy database at a single U.S. academic center. Patients with baseline examinations demonstrating tubular adenomas 1 to 9 mm in size with low-grade dysplasia and no advanced adenomas were included. Follow-up colonoscopies were performed at least 200 days later and were assessed for incident advanced neoplasia (cancer, high-grade dysplasia, adenoma ≥10 mm in size, or villous elements).

RESULTS

There were 2477 qualifying baseline colonoscopies. The absolute risk of metachronous advanced neoplasia increased from 3.6% in patients with 1 to 5 mm adenomas to 6.9% in patients with at least 1 adenoma of 6 to 9 mm (P = .001). Patients with 5 or more adenomas 1 of which was at least 6 to 9 mm had the highest risk of advanced neoplasia at follow-up (10.4%, P = .006). When only screening colonoscopies were considered, all baseline groups (1-2 adenomas, 3-4 adenomas, ≥5 adenomas) with adenomas 6 to 9 mm in size had an increased risk for metachronous advanced neoplasia (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.50-11.04; OR, 4.91; 95% CI, 1.44-16.75; OR, 4.71; 95% CI, 1.30-17.05, respectively).

CONCLUSIONS

Patients with baseline small (6-9 mm) adenomas have an increased risk of advanced lesions on follow-up compared with patients with only diminutive (1-5 mm) adenomas. Postpolypectomy guidelines should consider risk stratification based on small versus diminutive adenomas.

Authors+Show Affiliations

Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

31525360

Citation

Hartstein, Joseph D., et al. "The Predictive Value of Small Versus Diminutive Adenomas for Subsequent Advanced Neoplasia." Gastrointestinal Endoscopy, vol. 91, no. 3, 2020, pp. 614-621.e6.
Hartstein JD, Vemulapalli KC, Rex DK. The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia. Gastrointest Endosc. 2020;91(3):614-621.e6.
Hartstein, J. D., Vemulapalli, K. C., & Rex, D. K. (2020). The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia. Gastrointestinal Endoscopy, 91(3), 614-e6. https://doi.org/10.1016/j.gie.2019.08.047
Hartstein JD, Vemulapalli KC, Rex DK. The Predictive Value of Small Versus Diminutive Adenomas for Subsequent Advanced Neoplasia. Gastrointest Endosc. 2020;91(3):614-621.e6. PubMed PMID: 31525360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia. AU - Hartstein,Joseph D, AU - Vemulapalli,Krishna C, AU - Rex,Douglas K, Y1 - 2019/09/13/ PY - 2019/05/28/received PY - 2019/08/31/accepted PY - 2019/9/17/pubmed PY - 2021/2/23/medline PY - 2019/9/17/entrez SP - 614 EP - 621.e6 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 91 IS - 3 N2 - BACKGROUND AND AIMS: Patients with previous colorectal adenomas are at increased risk of colorectal cancer. Current guidelines for postpolypectomy surveillance intervals treat all tubular adenomas 1 to 9 mm in size with low-grade dysplasia as carrying the same level of risk. We evaluated whether 6 to 9 mm adenomas detected at colonoscopy are associated with greater risk of advanced neoplasia at follow-up compared with baseline 1 to 5 mm adenomas. METHODS: We retrospectively evaluated a colonoscopy database at a single U.S. academic center. Patients with baseline examinations demonstrating tubular adenomas 1 to 9 mm in size with low-grade dysplasia and no advanced adenomas were included. Follow-up colonoscopies were performed at least 200 days later and were assessed for incident advanced neoplasia (cancer, high-grade dysplasia, adenoma ≥10 mm in size, or villous elements). RESULTS: There were 2477 qualifying baseline colonoscopies. The absolute risk of metachronous advanced neoplasia increased from 3.6% in patients with 1 to 5 mm adenomas to 6.9% in patients with at least 1 adenoma of 6 to 9 mm (P = .001). Patients with 5 or more adenomas 1 of which was at least 6 to 9 mm had the highest risk of advanced neoplasia at follow-up (10.4%, P = .006). When only screening colonoscopies were considered, all baseline groups (1-2 adenomas, 3-4 adenomas, ≥5 adenomas) with adenomas 6 to 9 mm in size had an increased risk for metachronous advanced neoplasia (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.50-11.04; OR, 4.91; 95% CI, 1.44-16.75; OR, 4.71; 95% CI, 1.30-17.05, respectively). CONCLUSIONS: Patients with baseline small (6-9 mm) adenomas have an increased risk of advanced lesions on follow-up compared with patients with only diminutive (1-5 mm) adenomas. Postpolypectomy guidelines should consider risk stratification based on small versus diminutive adenomas. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/31525360/The_predictive_value_of_small_versus_diminutive_adenomas_for_subsequent_advanced_neoplasia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(19)32240-0 DB - PRIME DP - Unbound Medicine ER -