Long term outcomes of colon polyps with high grade dysplasia following endoscopic resection
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RESEARCH ARTICLE
Open Access
Long term outcomes of colon polyps with high grade dysplasia following endoscopic resection Jia‑Jang Chang1,2, Cheng‑Hung Chien1,2, Shuo‑Wei Chen1,2, Li‑Wei Chen1,2, Ching‑Jung Liu1,2 and Cho‑Li Yen1,2*
Abstract Background: The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypec‑ tomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. Methods: 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. Results: Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at followup were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3–12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recur‑ rence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06–9.04 95% CI), 3.47 (1.67–7.22 95% CI), 2.55 (1.11–5.89 95% CI), 2.46 (1.16–5.22 95% CI), 2.89 (1.44– 5.78 95% CI), respectively. Multivariate analysis revealed gender (male) [P = 0.010; OR 3.09(1.32–7.25 95% CI)] and adenoma count ≥ 3 [P = 0.002; OR 3.08(1.52–6.24 95% CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. Conclusion: Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present. Keywords: Colonoscopy, Colon polyp, High grade dysplasia, Surveillance Background Colorectal cancer (CRC) is the third leading cause of cancer-related death in Taiwan [1]. CRCs originate from the initially benign colon adenomas that subsequently undergo an adenoma-carcinoma transition sequence. Polypectomy interrupts this sequence and reduces the incidence of CRC [2–5]. The occurrence of CRC can also be effectively prevented by detecting and excising *Correspondence: [email protected]; [email protected] 1 Division of Hepatogastroenterology, Keelung Chang Gung Memorial Hospital, No. 222, Mai Chin Road, Keelung 204, Taiwan Full list of author information is available at the end of the article
advanced adenomas, which are defined as larger than 10 mm, displaying a high grade dysplasia (HGD), and/ or ≥ 20% villous [6]. The 5-year rate of recurrence for colonic adenoma following polypectomy range between 29–58% [5, 7], and previous studies have suggested that adenoma traits at index colonoscopy are closely related to recurrence. Specifically, location, size, histological type, presence of atypia, and number of adenomas detected at index colonoscopy are known ris
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