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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(09): E849-E858
DOI: 10.1055/a-2124-9788
Original article

Large serrated polyps indicate a greater risk of advanced metachronous colorectal neoplasia than high-grade adenomas

Edgard Medawar
1   Department of Medicine, University of Ottawa, Ottawa, Canada (Ringgold ID: RIN6363)
2   University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada (Ringgold ID: RIN5622)
,
Roupen Djinbachian 
2   University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada (Ringgold ID: RIN5622)
3   Division of Gastroenterology, University of Montreal Hospital Centre, Montreal, Canada (Ringgold ID: RIN25443)
,
Mahsa Taghiakbari
2   University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada (Ringgold ID: RIN5622)
,
Tommy Khoury
2   University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada (Ringgold ID: RIN5622)
,
Amine Zoughlami
4   Department of Medicine, McGill University, Montreal, Canada (Ringgold ID: RIN5620)
,
Melissa Zarandi-Nowroozi
2   University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada (Ringgold ID: RIN5622)
3   Division of Gastroenterology, University of Montreal Hospital Centre, Montreal, Canada (Ringgold ID: RIN25443)
,
Widad Safih
2   University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada (Ringgold ID: RIN5622)
,
Daniel von Renteln 
2   University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada (Ringgold ID: RIN5622)
3   Division of Gastroenterology, University of Montreal Hospital Centre, Montreal, Canada (Ringgold ID: RIN25443)
› Author AffiliationsSupported by: Canadian Institutes of Health Research Canada Graduate Scholarships
Supported by: American College of Gastroenterology Resident Research Award
Supported by: Fonds de Recherche du Québec – Santé Career Development Award
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Abstract

Background and study aims The risk of developing total metachronous advanced neoplasia (TMAN) in patients with index serrated lesions (SL) or adenoma with high-grade dysplasia (HGD) is unknown. We evaluated this risk in patients with either HGD, SL < 10 mm or SL ≥ 10 mm at index colonoscopy, who underwent surveillance colonoscopies.

Patients and methods This retrospective cohort study evaluated all consecutive patients (n = 2477) diagnosed between 2010 and 2019 with colorectal HGD, SLs < 10 mm or SLs ≥ 10 mm. We excluded patients aged < 45 or > 75 years or those who had inflammatory bowel disease, hereditary colorectal cancer (CRC) syndromes, previous or synchronous CRC, or no follow-up colonoscopy. Descriptive variables were compared using analysis of variance or Pearson chi-squared tests. Multivariate Cox regressions were used to compare the risk of TMAN between the HGD, SL < 10 mm and SL ≥ 10 mm groups.

Results Overall, 585 patients (mean age 63 years; 55% male; mean follow-up 3.67 years) were included (226 with SLs < 10 mm, 204 with SLs ≥ 10 mm, 155 with HGD). Compared with SLs < 10 mm, patients with HGD did not have a significantly different rate of TMAN (HR=0.75 [0.39–1.44]) and patients with SLs ≥ 10 mm had a higher rate of TMAN (HR=2.08 [1.38–3.15]). Compared with HGD, patients with SLs ≥ 10 mm had a higher rate of TMAN (HR=1.87 [1.04–3.36]).

Conclusions The risk for TMAN was higher for patients with SLs ≥ 10 mm than with HGD or SLs < 10 mm. This risk should be considered when planning surveillance intervals for patients diagnosed with large SLs.

Keywords

CRC screening - Colorectal cancer - Endoscopy Lower GI Tract - Polyps / adenomas / ... - Endoscopic resection (polypectomy, ESD, EMRc, ...) - Tissue diagnosis

Supporting information



Publication History

Received: 23 December 2022

Accepted after revision: 04 July 2023

Accepted Manuscript online:
06 July 2023

Article published online:
15 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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