The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia
dc.contributor.author | Hartstein, Joseph D. | |
dc.contributor.author | Vemulapalli, Krishna C. | |
dc.contributor.author | Rex, Douglas K. | |
dc.contributor.department | Medicine, School of Medicine | en_US |
dc.date.accessioned | 2019-12-06T18:02:04Z | |
dc.date.available | 2019-12-06T18:02:04Z | |
dc.date.issued | 2019 | |
dc.description.abstract | Background and Aims Patients with previous colorectal adenomas are at increased risk of colorectal cancer. Current guidelines for postpolypectomy surveillance intervals treat all tubular adenomas 1 to 9 mm in size with low-grade dysplasia as carrying the same level of risk. We evaluated whether 6 to 9 mm adenomas detected at colonoscopy are associated with greater risk of advanced neoplasia at follow-up compared with baseline 1 to 5 mm adenomas. Methods We retrospectively evaluated a colonoscopy database at a single U.S. academic center. Patients with baseline examinations demonstrating tubular adenomas 1 to 9 mm in size with low-grade dysplasia and no advanced adenomas were included. Follow-up colonoscopies were performed at least 200 days later and were assessed for incident advanced neoplasia (cancer, high-grade dysplasia, adenoma ≥10 mm in size, or villous elements). Results There were 2477 qualifying baseline colonoscopies. The absolute risk of metachronous advanced neoplasia increased from 3.6% in patients with 1 to 5 mm adenomas to 6.9% in patients with at least 1 adenoma of 6 to 9 mm (P = .001). Patients with 5 or more adenomas 1 of which was at least 6 to 9 mm had the highest risk of advanced neoplasia at follow-up (10.4%, P = .006). When only screening colonoscopies were considered, all baseline groups (1-2 adenomas, 3-4 adenomas, ≥5 adenomas) with adenomas 6 to 9 mm in size had an increased risk for metachronous advanced neoplasia (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.50-11.04; OR, 4.91; 95% CI, 1.44-16.75; OR, 4.71; 95% CI, 1.30-17.05, respectively). Conclusions Patients with baseline small (6-9 mm) adenomas have an increased risk of advanced lesions on follow-up compared with patients with only diminutive (1-5 mm) adenomas. Postpolypectomy guidelines should consider risk stratification based on small versus diminutive adenomas. | en_US |
dc.eprint.version | Author's manuscript | en_US |
dc.identifier.citation | Hartstein, J. D., Vemulapalli, K. C., & Rex, D. K. (2019). The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia. Gastrointestinal Endoscopy. https://doi.org/10.1016/j.gie.2019.08.047 | en_US |
dc.identifier.uri | https://hdl.handle.net/1805/21433 | |
dc.language.iso | en | en_US |
dc.publisher | Elsevier | en_US |
dc.relation.isversionof | 10.1016/j.gie.2019.08.047 | en_US |
dc.relation.journal | Gastrointestinal Endoscopy | en_US |
dc.rights | Publisher Policy | en_US |
dc.source | Publisher | en_US |
dc.subject | adenomas | en_US |
dc.subject | advanced neoplasia | en_US |
dc.subject | colorectal cancer | en_US |
dc.title | The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia | en_US |
dc.type | Article | en_US |