New Gastric Lesion in the Cardia Induced by Proton Pump Inhibitor Treatment

Abstract

BACKGROUND: Incomplete resection of adenomatous polyps likely contributes to interval colorectal carcinomas following a complete colonoscopy. However, data on adequacy of adenoma resection is lacking. OBJECTIVE: Examine the rate of incompletely resected adenomatous polyps. METHODS: We prospectively enrolled individuals presenting for colonoscopy at two medical centers and studied those found with at least one non-pedunculated polyp between 5 and 20mm. After obtaining a standardized measure of polyp size, polyps were removed by experienced Attending Gastroenterologists using snare polypectomy with cautery. Once polyp removal was considered complete, either two or four biopsies were obtained from the resection margin for 5-9mm polyps and 10-20mm, respectively. Adenomatous polyps were considered incompletely resected if any of the marginal biopsies contained adenomatous tissue. The main outcome measure was the rate of incompletely resected adenomas overall and by size. We performed regression analysis to examine the association between incomplete resection and size, anatomic location, and location with respect to colonic folds. RESULTS: 417 study polyps were removed from 271 patients (83.4% men, mean age 63.4 years) by 11 Gastroenterologists. 345 of these polyps were adenomatous (n=344) or contained cancer (n=1), and 64 polyps were hyperplastic with the remaining being juvenile, inflammatory, or mucosal prolapse. The overall incomplete adenoma resection rate was 10.1% (95%CI 6.9-13.3%). Incomplete resection was significantly more common for large adenomas (17.4%, 95%CI 10.2-24.7%) relative to small adenomas (6.8%, 95%CI 3.5%-10.0%; p=0.002). In adjusted regression analysis, large adenomas were 2.5 times more likely than small adenomas to be incompletely removed (OR=2.5, CI 1.15.3). Incomplete resection was common for serrated adenomas with an overall incomplete resection rate of 31.5% (95% CI 16.6-44.9%) and a 50.0% (95%CI 27.3-72.7) rate for large serrated adenomas. Distal or proximal location in the colon or the location of the polyp on or behind a fold was not associated with incomplete resection. CONCLUSION: Even under study conditions experienced Gastroenterologists incompletely resected a high proportion of adenomas. Assuming that microscopic residual adenomatous tissue is clinically important, additional efforts need to be implemented to ensure complete resection, especially of larger lesions.