Risk of developing advanced colorectal neoplasia after removing high‐risk adenoma detected at index colonoscopy in young patients: A KASID study

Park, Soo-Kyung; Kim, Nam Hee; Jung, Yoon Suk; Kim, Wonhee; Eun, Chang Soo; Ko, Bong Min; Seo, Geom Seog; Myung, Jae; Park, Sung Chul; Kim, Kyeong Ok; Moon, Chang Mo; Jung, Yoon-Ho; Kim, Eun Soo; Jeon, Seong Ran; Lee, Chang Kyun; Park, Dong Il

doi:10.1111/jgh.13167

Cited by 24 publications

(29 citation statements)

References 39 publications

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“…Our study included patients who were free of both low-risk and high-risk adenomas at baseline colonoscopy and showed that old age was strongly associated with the development of overall and high-risk adenomas. These results are consistent with those of large-scale stud- ies [6,8,9] that focused on advanced adenoma. To the best of our knowledge, this is the first report indicating that old age is a significant risk factor for high-risk adenomas at surveillance colonoscopy.…”

Section: Discussionsupporting

confidence: 81%

“…However, the association between age and recurrent adenoma has differed from study to study. Recent several large-scale studies have reported that age is a significant predictor of advanced adenoma [6,8,9]; a pooled analysis reported that patient age had the strongest association with the risk of metachronous advanced adenoma [6]. Park et al [8] also demonstrated that the recurrence of overall and advanced adenoma was related to old age.…”

Section: Discussionmentioning

confidence: 90%

“…A pooled analysis of 8 prospective studies showed that patient age and adenoma size and number had the strongest associations with the risk of metachronous advanced adenoma [6]. In Asia, previous studies demonstrated that the recurrence rates of overall and advanced adenoma were related to old age [8][9][10]. However, these studies focused on advanced adenoma but not on high-risk adenoma.…”

Section: Introductionmentioning

confidence: 94%

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Predictors of High-Risk Adenoma Occurrence at Surveillance Colonoscopy in Patients Who Undergo Colorectal Adenoma Removal

Liu

Seo

Sim

et al. 2018

Dig Dis

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Objectives: Surveillance colonoscopy is recommended after polypectomy because adenoma recurrence is common. The aim of this study was to evaluate the predictors of high-risk adenoma occurrence at surveillance colonoscopy in patients who undergo colorectal adenoma removal and to clarify the association between age and recurrent colorectal adenoma. Methods: This retrospective study included 563 patients who had colorectal adenomas at baseline colonoscopy and who underwent surveillance colonoscopy. The risk factors for recurrent adenoma were evaluated and the 5-year cumulative incidence rates of overall and high-risk adenoma were compared according to age group. Results: During a mean follow-up period of 3.1 years, 305 (54.2%) patients had overall adenoma recurrence, and 80 (14.2%) patients had high-risk adenoma at surveillance colonoscopy. In a multivariate analysis, old age (≥60 years) and presence of multiple adenomas (3 or more) were significantly associated with high-risk adenoma (p = 0.002 and p = 0.006 respectively). The 5-year cumulative incidence rates of high-risk adenoma were 7.4, 16.7, and 24.1% in the < 50, 50–59, and ≥60 years group respectively (p < 0.001). Conclusions: Old age (≥60 years) and presence of multiple adenomas (3 or more) were strongly associated with the occurrence of high-risk adenoma at surveillance colonoscopy. The 5-year cumulative incidence of high-grade adenoma was significantly high in the old age group.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 94%

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Predictors of High-Risk Adenoma Occurrence at Surveillance Colonoscopy in Patients Who Undergo Colorectal Adenoma Removal

Liu

Seo

Sim

et al. 2018

Dig Dis

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“…When the outcome measure was detection of AN, at surveillance, the findings were similar, with five studies rated as low to moderate risk of bias12 98–101 identified. Four of the five studies reported significant associations, showing increased risk for AN at first surveillance if tubulovillous or villous components (rather than tubular) were identified at index.…”

Section: Resultsmentioning

confidence: 69%

“…Five studies12 98–101 only reported statistical analyses on AN, with four reporting no significant association between HGD at index and risk of AN at first surveillance, and the fifth study (Cubiella et al 100) reporting an OR of 0.7 (95% CI 0.5 to 0.98), consistent with reduced risk associated with HGD. Again, risk of bias was generally rated as moderate to low.…”

Section: Resultsmentioning

confidence: 98%

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

Rutter

East

Rees

et al. 2019

Gut

276

376

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These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped?two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThe Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG’s guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThe key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThis cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.

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Risk of advanced neoplasia after removal of colorectal adenomas with high-grade dysplasia

He,

Wang,

Zhang

et al. 2024

Surg Endosc

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Background Many studies reported the presence of adenomas with high-grade dysplasia (HGD) at index colonoscopy increased the incidence of advanced neoplasia (AN) and colorectal cancer (CRC) following. However, the conclusion remains obscure due to lack of studies on the specific population of adenomas with HGD. This study aimed to assess the long-term risk of AN and CRC after removal of adenomas with HGD. Methods A total of 814 patients who underwent adenomas with HGD removal between 2010 and 2019 were retrospectively analyzed. The outcomes were the incidences of AN and CRC during surveillance colonoscopy. Cox proportional hazards models were utilized to identify risk factors associated with AN and CRC. Results During more than 2000 person-years of follow-up, we found that AN and CRC incidence densities were 44.3 and 4.4 per 1000 person-years, respectively. The 10-year cumulative incidence of AN and CRC were 39.1% and 5.5%, respectively. In the multivariate model, synchronous low-risk polyps (HR 1.80, 95% CI 1.10–2.93) and synchronous high-risk polyps (HR 3.99, 95% CI 2.37–6.72) were risk factors for AN, whereas participation in surveillance colonoscopy visits (HR 0.56, 95% CI 0.36–0.88 for 1 visit; HR 0.10, 95% CI 0.06–0.19 for ≥ 2 visits) were associated with decreased AN incidence. Additionally, elevated baseline carcinoembryonic antigen (CEA) level (HR 10.19, 95% CI 1.77–58.59) was a risk factor for CRC, while participation in ≥ 2 surveillance colonoscopy visits (HR 0.11, 95% CI 0.02–0.56) were associated with decreased CRC incidence. Interestingly, for 11 patients who developed CRC after removal of adenomas with HGD, immunohistochemistry revealed that 8 cases (73%) were deficient mismatch repair CRCs. Conclusions Patients who have undergone adenoma with HGD removal are at higher risk of developing AN and CRC, while surveillance colonoscopy can reduce the risk. Patients with synchronous polyps, or with elevated baseline CEA level are considered high-risk populations and require more frequent surveillance.

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Risk of developing advanced colorectal neoplasia after removing high‐risk adenoma detected at index colonoscopy in young patients: A KASID study

Abstract: The cumulative incidence of overall and advanced colorectal neoplasms was significantly higher in older patients than in young patient groups. Age was a significant risk factor for developing colorectal neoplasms after removing high-risk adenoma.

Cited by 24 publications

References 39 publications

Predictors of High-Risk Adenoma Occurrence at Surveillance Colonoscopy in Patients Who Undergo Colorectal Adenoma Removal

Predictors of High-Risk Adenoma Occurrence at Surveillance Colonoscopy in Patients Who Undergo Colorectal Adenoma Removal

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

Risk of advanced neoplasia after removal of colorectal adenomas with high-grade dysplasia

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