Risk of Metachronous Advanced Neoplasia in Patients With Multiple Diminutive Adenomas. (December 2018)

• Record Type: Journal Article
• Authors: Kim, Jung Yoon; Kim, Tae Jun; Baek, Sun‐Young; Ahn, Soohyun; Kim, Eun Ran; Hong, Sung Noh; Chang, Dong Kyung; Kim, Young‐Ho
• Is Part Of: American journal of gastroenterology. Volume 113:Number 12(2018)
• Publication Date: 2018-12
• Subjects: Stomach -- Diseases -- Periodicals; Intestines -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Gastrointestinal Diseases -- Periodicals; Electronic journals; Periodicals; 616.33
• DOI: 10.1038/s41395-018-0210-9
• Languages: English
• ISSNs: 0002-9270

Abstract

Abstract : OBJECTIVES: Individuals with advanced adenomas or three or more adenomas have a higher risk of metachronous advanced neoplasia (AN) and are recommended to undergo surveillance colonoscopy at shorter intervals. However, it is questionable whether patients with multiple (three or more) non‐advanced diminutive adenomas should be considered as high‐risk. METHODS: We analyzed 5482 patients diagnosed with one or more adenomas during their first colonoscopy screening and who underwent a follow‐up colonoscopy. Patients were categorized into four groups based on adenoma characteristics at baseline: Group 1, 1‐2 non‐advanced adenomas; Group 2, ≥3 non‐advanced, diminutive (1 to 5 mm) adenomas; Group 3, ≥3 non‐advanced, small (6‐9 mm) adenomas; and Group 4, advanced adenomas. RESULTS: During a median follow‐up of 38 months, the incidence of metachronous AN at surveillance colonoscopy was 5.6%. The incidence of AN was 3.9% in group 1, 5.9% in group 2, 10.6% in group 3, and 22.1% in group 4. The adjusted hazard ratios (HRs) [95% confidence intervals (CIs)] for metachronous AN between group 2, group 3, and group 4, and low risk group 1 were 1.71 (0.99‐2.94), 2.76 (1.72‐4.44), and 5.23 (3.57‐7.68), respectively. Compared with group 4, the adjusted HRs (95% CIs) for group 1, group 2, and group 3 were 0.19 (0.13‐0.28), 0.32 (0.18‐0.59), and 0.52 (0.31‐0.89), respectively. CONCLUSIONS: We found that patients with three or more non‐advanced diminutive adenomas had a borderline increased risk of metachronous AN compared with patients with low risk adenomas.