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Risk of Metachronous Advanced Colorectal Neoplasia After Removal of Diminutive Versus Small Nonadvanced Adenomas: A Multicenter Study

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An Editorial to this article was published on 09 July 2022

Abstract

Background

Current postpolypectomy guidelines treat 1–9 mm nonadvanced adenomas (NAAs) as carrying the same level of risk for metachronous advanced colorectal neoplasia (ACRN).

Aims

To evaluate whether small (6–9 mm) NAAs are associated with a greater risk of metachronous ACRN than diminutive (1–5 mm) NAAs.

Methods

We retrospectively evaluated 10,060 index colonoscopies performed from July 2011 to June 2019. A total of 1369 patients aged ≥ 40 years with index NAAs and having follow-up examinations were categorized into 5 groups based on size and number of index findings: Group 1, ≤ 2 diminutive NAAs (n = 655); Group 2, ≤ 2 small NAAs (n = 529); Group 3, 3–4 diminutive NAAs (n = 78); Group 4, 3–4 small NAAs (n = 65); and Group 5, 5–10 NAAs (n = 42). Size was classified based on the largest NAA. ACRN was defined as finding an advanced adenoma or colorectal cancer at follow-up.

Results

The absolute risk of metachronous ACRN increased from 7.2% in patients with all diminutive NAAs to 12.2% in patients with at least 1 small NAA (P = 0.002). Patients in Group 2 (adjusted odds ratio [AOR] 1.89; 95% confidence interval [CI], 1.21–2.95), Group 3 (AOR 2.40; 95% CI 1.78–4.90), Group 4 (AOR 2.77; 95% CI 1.35–5.66), and Group 5 (AOR 3.71; 95% CI 1.65–8.37) were associated with an increased risk of metachronous ACRN compared with Group 1.

Conclusions

Patients with small NAAs have an increased risk of metachronous ACRN. Postpolypectomy guidelines should consider including risk stratification between small and diminutive adenomas.

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Acknowledgments

The authors declare no grant or financial support.

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Authors and Affiliations

  1. Division of Gastroenterology, Evergreen General Hospital, 150 Huan-Zhong East Road, Zhongli District, Taoyuan, 320, Taiwan, ROC

    Chi-Liang Cheng, Yen-Lin Kuo, Yi-Ning Tsui & Bai-Ping Lee

  2. Division of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, 222 Maijin Road, Keelung, 204, Taiwan, ROC

    Shuo-Wei Chen, Tsuo-Hsuan Chien, Yuh-Ying Liu, Kuang-Chen Huang & Cheng-Han Xie

  3. School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC

    Shuo-Wei Chen, Chi-Huang Wu, Mu-Hsien Lee & Nai-Jen Liu

  4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 252 Wuxing Street, Xinyi District, Taipei, 110, Taiwan, ROC

    I-Chia Su & Jui-Hsiang Tang

  5. Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 333, Taiwan, ROC

    Chi-Huang Wu, Mu-Hsien Lee & Nai-Jen Liu

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  1. Chi-Liang Cheng
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ICS, CHW, YLK, THC, YYL, KCH, CHX, MHL, YNT, and BPL. The first draft of the manuscript was written by CLC, SWC, JHT, and NJL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Chi-Liang Cheng.

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An editorial commenting on this article is available at https://doi.org/10.1007/s10620-022-07612-7.

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Cheng, CL., Chen, SW., Su, IC. et al. Risk of Metachronous Advanced Colorectal Neoplasia After Removal of Diminutive Versus Small Nonadvanced Adenomas: A Multicenter Study. Dig Dis Sci 68, 259–267 (2023). https://doi.org/10.1007/s10620-022-07608-3

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