Abstract
BackgroundThe risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors.Methods11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis.ResultsData from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3–12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06–9.04 95% CI), 3.47 (1.67–7.22 95% CI), 2.55 (1.11–5.89 95% CI), 2.46 (1.16–5.22 95% CI), 2.89 (1.44–5.78 95% CI), respectively. Multivariate analysis revealed gender (male) [P = 0.010; OR 3.09(1.32–7.25 95% CI)] and adenoma count ≥ 3 [P = 0.002; OR 3.08(1.52–6.24 95% CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma.ConclusionRecurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.
Highlights
The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear
Patients with adenoma at screening and who underwent subsequent surveillance colonoscopy were filtered, and cases involving HGD colon adenoma were selected for review
Cases with a history of typical or metachronous colon cancer at time of index study, inflammatory bowel disease, familial adenomatous polyposis (FAP), a lack of surveillance total colonoscopy within three years of screen polypectomy, incomplete colonoscopy results, or other disease that led to death within the study period were excluded
Summary
The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. CRCs originate from the initially benign colon adenomas that subsequently undergo an adenoma-carcinoma transition sequence. Polypectomy interrupts this sequence and reduces the incidence of CRC [2,3,4,5]. A univariate analysis using NCI Pooling Project data, adenomas with HGD were shown to be strongly associated with risk of advanced neoplasia by follow-up colonoscopy (OR, 1.77; 95% CI, 1.41–2.22) [11]. This finding was not duplicated in other studies. We conducted this retrospective cohort study with the primary goals of elucidating a general recurrence rate for advanced neoplasia in patients with HGD polyps at baseline screening, as well as the relationship between baseline endoscopic findings and risk of developing advanced neoplasia
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