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Risk of Metachronous Advanced Neoplasia in Patients With Multiple Diminutive Adenomas

The American Journal of Gastroenterology (2018) | Download Citation




Individuals with advanced adenomas or three or more adenomas have a higher risk of metachronous advanced neoplasia (AN) and are recommended to undergo surveillance colonoscopy at shorter intervals. However, it is questionable whether patients with multiple (three or more) non-advanced diminutive adenomas should be considered as high-risk.


We analyzed 5482 patients diagnosed with one or more adenomas during their first colonoscopy screening and who underwent a follow-up colonoscopy. Patients were categorized into four groups based on adenoma characteristics at baseline: Group 1, 1-2 non-advanced adenomas; Group 2, ≥3 non-advanced, diminutive (1 to 5 mm) adenomas; Group 3, ≥3 non-advanced, small (6–9 mm) adenomas; and Group 4, advanced adenomas.


During a median follow-up of 38 months, the incidence of metachronous AN at surveillance colonoscopy was 5.6%. The incidence of AN was 3.9% in group 1, 5.9% in group 2, 10.6% in group 3, and 22.1% in group 4. The adjusted hazard ratios (HRs) [95% confidence intervals (CIs)] for metachronous AN between group 2, group 3, and group 4, and low risk group 1 were 1.71 (0.99–2.94), 2.76 (1.72–4.44), and 5.23 (3.57–7.68), respectively. Compared with group 4, the adjusted HRs (95% CIs) for group 1, group 2, and group 3 were 0.19 (0.13–0.28), 0.32 (0.18–0.59), and 0.52 (0.31–0.89), respectively.


We found that patients with three or more non-advanced diminutive adenomas had a borderline increased risk of metachronous AN compared with patients with low risk adenomas.

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  1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    • Jung Yoon Kim MD
    • , Tae Jun Kim MD
    • , Eun Ran Kim MD, PhD
    • , Sung Noh Hong MD, PhD
    • , Dong Kyung Chang MD, PhD
    •  & Young-Ho Kim MD, PhD
  2. Statistics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    • Sun-Young Baek MS
  3. Department of Mathematics, Ajou University, Suwon, Korea

    • Soohyun Ahn PhD


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Young-Ho Kim, MD, PhD.

Specific author contributions

Study concept and design: Tae Jun Kim and Young-Ho Kim. Acquisition, analysis, or interpretation of data: Jung Yoon Kim and Tae Jun Kim. Writing and drafting of the manuscript: Jung Yoon Kim and Tae Jun Kim. Critical revision of the manuscript for important intellectual content: Tae Jun Kim, Eun Ran Kim, Sung Noh Hong, Dong Kyung Chang, and Young-Ho Kim. Statistical analysis: Sun-Young Baek and Soo Hyun Ahn. Study supervision: Young-Ho Kim. All authors approved the final submission.

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Correspondence to Tae Jun Kim MD or Young-Ho Kim MD, PhD.

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