Article | Published:

Risk of Metachronous Advanced Neoplasia in Patients With Multiple Diminutive Adenomas

The American Journal of Gastroenterology (2018) | Download Citation

Subjects

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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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References

  1. 1.

    Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–73.

  2. 2.

    Citarda F, Tomaselli G, Capocaccia R, et al. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48:812–5.

  3. 3.

    Loeve F, van Ballegooijen M, Snel P, et al. Colorectal cancer risk after colonoscopic polypectomy: a population-based study and literature search. Eur J Cancer. 2005;41:416–22.

  4. 4.

    Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658–62.

  5. 5.

    Bertario L, Russo A, Sala P, et al. Predictors of metachronous colorectal neoplasms in sporadic adenoma patients. Int J Cancer. 2003;105:82–7.

  6. 6.

    Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872–85.

  7. 7.

    Hong SN, Yang D-H, Kim Y-H, et al. Korean guidelines for post-polypectomy colonoscopic surveillance. Korean J Gastroenterol. 2012;59:99–117.

  8. 8.

    Martinez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology. 2009;136:832–41.

  9. 9.

    Chung SJ, Kim YS, Yang SY, et al. Five-year risk for advanced colorectal neoplasia after initial colonoscopy according to the baseline risk stratification: a prospective study in 2452 asymptomatic Koreans. Gut. 2011;60:1537–43.

  10. 10.

    Hassan C, Quintero E, Dumonceau JM, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2013;45:842–51.

  11. 11.

    Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844–57.

  12. 12.

    Cottet V, Jooste V, Fournel I, et al. Long-term risk of colorectal cancer after adenoma removal: a population-based cohort study. Gut. 2012;61:1180–6.

  13. 13.

    Laiyemo AO, Murphy G, Albert PS, et al. Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med. 2008;148:419–26.

  14. 14.

    de Jonge V, Sint Nicolaas J, van Leerdam ME, et al. Systematic literature review and pooled analyses of risk factors for finding adenomas at surveillance colonoscopy. Endoscopy. 2011;43:560–72.

  15. 15.

    Saini SD, Kim HM, Schoenfeld P. Incidence of advanced adenomas at surveillance colonoscopy in patients with a personal history of colon adenomas: a meta-analysis and systematic review. Gastrointest Endosc. 2006;64:614–26.

  16. 16.

    Kahi CJ, Hewett DG, Norton DL, et al. Prevalence and variable detection of proximal colon serrated polyps during screening colonoscopy. Clin Gastroenterol Hepatol. 2011;9:42–6.

  17. 17.

    Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007;133:1077–85.

  18. 18.

    Sneh Arbib O, Zemser V, Leibovici Weissman Y, et al. Risk of advanced lesions at the first follow-up colonoscopy after polypectomy of diminutive versus small adenomatous polyps of low-grade dysplasia. Gastrointest Endosc. 2017;86:713–21 e2.

  19. 19.

    Jeong YH, Kim KO, Park CS, et al. Risk factors of advanced adenoma in small and diminutive colorectal polyp. J Korean Med Sci. 2016;31:1426–30.

  20. 20.

    Gupta N, Bansal A, Rao D, et al. Prevalence of advanced histological features in diminutive and small colon polyps. Gastrointest Endosc. 2012;75:1022–30.

  21. 21.

    Rex DK, Overhiser AJ, Chen SC, et al. Estimation of impact of American College of Radiology recommendations on CT colonography reporting for resection of high-risk adenoma findings. Am J Gastroenterol. 2009;104:149–53.

  22. 22.

    Brenner H, Chang-Claude J, Seiler CM, et al. Long-term risk of colorectal cancer after negative colonoscopy. J Clin Oncol. 2011;29:3761–7.

  23. 23.

    Imperiale TF, Glowinski EA, Lin-Cooper C, et al. Five-year risk of colorectal neoplasia after negative screening colonoscopy. N Engl J Med. 2008;359:1218–24.

  24. 24.

    Noshirwani KC, van Stolk RU, Rybicki LA, et al. Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy. Gastrointest Endosc. 2000;51:433–7.

  25. 25.

    Ponugoti PL, Rex DK. Yield of a second screening colonoscopy 10 years after an initial negative examination in average-risk individuals. Gastrointest Endosc. 2017;85:221–4.

  26. 26.

    Kim TJ, Kim ER, Hong SN, et al. Adenoma detection rate influences the risk of metachronous advanced colorectal neoplasia in low-risk patients. Gastrointest Endosc. 2018;87:809–17 e1.

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Author information

Affiliations

  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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Guarantor of the article

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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None.

Potential competing interests

None.

Corresponding authors

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

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DOI

https://doi.org/10.1038/s41395-018-0210-9