S206 Clinical Characteristics of Young Patients With Colonic Adenomas

Abstract

Introduction: The incidence of colonic adenomas and colorectal cancer has been rising among young patients. Studies addressing the prevalence, risk factors, patient characteristics and appropriate surveillance intervals in young patients with adenomas are limited. In this study, we aim at describing the characteristics of young patients (< 50 years of age) with adenomatous polyps and characterizing those polyps. Methods: This was a retrospective chart review of the Department of Gastroenterology database to identify patients < 50 years of age who had polyp(s) on colonoscopy done between 2008 and 2021. Patient demographics, colonoscopy indication, and number, size, location, and pathology of polyps were documented. Timing and findings of follow-up colonoscopies were recorded. Patients with personal history of inflammatory bowel disease, personal or family history of colorectal cancer were excluded. Results: 877 patients were included in the study; mean age 42.4 ± 6.3 years, 62% males, mean BMI 27.7 ± 5.0. Colonoscopy indications were abdominal pain (26%), rectal bleeding (22%), change in bowel habits (17%), and evaluation of abnormal imaging/lab values. Of 877 patients, 610 (70%) had at least one adenoma: 571 (65%) tubular adenomas, 29 (3%) tubulovillous adenomas, 1 villous adenoma and 19 (2%) had sessile serrated adenomas. 267 (31%) patients had only hyperplastic polyps. Of patients with adenomas, 63 had a polyp > 10mm with mean polyp size 11 ± 9mm. 41% of patients had adenomas in the sigmoid, 34% in ascending, 27% in transverse, 24% in descending colon, and 22% in the rectum. Almost half (49%) of patients with adenomas were younger than 45 years and had similar demographic characteristics as patients between 45 and 50 years of age, but they had a larger mean polyp size (Table). Of the 610 patients with adenoma, 156 (26%) had a follow-up colonoscopy after a mean time of 2.9 ± 2.3 years, with 74 (47%) patients developing recurrent adenomas. 38 (6%) patients had a second follow-up after 2.1 ± 1.6 years and 15/38 had adenomas. Conclusion: Patients < 50 years of age with colonic adenomas were mostly males and overweight. Recurrence of adenomas was prevalent over the follow up of 3 years. For patients with GI complaints, colonoscopy should be considered in individuals with high-risk baseline characteristics. High rates of recurrent adenomas and larger polyp size in patients < 45 years of age may warrant more frequent surveillance than is done for patients > 45 years of age. Table 1. - Comparison of Demographics and Polyp Characteristics between Patients Younger than 45 Years of Age and Patients 45 to 50 Years of Age with Adenomatous Polyps Patients Younger than 45 Years of Age (N=299) Patients between 45 and 50 Years of Age (N=311) p-value Mean Age at Colonoscopy 38.27 (n=299) 47.45 (n=311) < 0.001 Males 58.6% (n=299) 63.0% (n=311) 0.256 BMI 26.77 (n=174) 28.20 (n=186) 0.886 Vitamin D Level 20.82 (n=161) 23.28 (n=186) 0.403 Smoking 50.0% (n=270) 51.6% (n=279) 0.705 Mean Size of Polyps 1.21 (n=109) 1.01 (n=97) < 0.001 High Risk Patients* 24.7% (n=299) 30.2% (n=311) 0.130 Follow Up Rate 24.7% (n=299) 26.1% (n=311) 0.713 BMI: Body Mass Index. N: Total number of patients. n: Total number of patients used to calculate a mean or a percentage.*High Risk patients are defined as having three or more adenomatous polyps and/or a villous component on pathology and/or a polyp size >1cm.