Adenomas with high‐grade dysplasia and early adenocarcinoma are more likely to be sessile in the proximal colon

Sawhney, Mandeep S.; Dickstein, Jacob; LeClair, John; Lembo, Cara; Yee, Eric U.

doi:10.1111/codi.12911

Cited by 14 publications

(14 citation statements)

References 21 publications

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“…The issue of the "biology" of proximal versus distal lesions has been a matter of controversy; recent retrospective analyses have reported that proximally located adenomas with HGD were significantly smaller 19 or that proximal locations were associated with a higher rate of malignancy. 20 However, the present results are in line with those of other studies showing contradictory evidence: recurrence rates after polypectomy (a possible indicator for more aggressive biology) were equivalent or even lower in the proximal colon. 21,22 In addition, the mortality rate from CRC after polypectomy was not found to be higher with right-sided adenomas in the Norwegian cancer registry.…”

Section: Discussionsupporting

confidence: 92%

Risk of Malignancy in Adenomas Detected During Screening Colonoscopy

Rösch

Altenhofen²,

Kretschmann³

et al. 2018

Clinical Gastroenterology and Hepatology

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In this large screening database, it was found that the rates of adenomas with HGD are similar in the proximal and distal colon. The presence of HGD as a risk marker alone does not explain higher rates of proximal interval colorectal cancer. We suggest that certain lesions (flat, serrated lesions) may be missed in the proximal colon and may acquire a more aggressive biology over time. A combination of endoscopy-related factors and biology may therefore account for higher rates of proximal versus distal interval colorectal cancer.

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Section: Discussionsupporting

confidence: 92%

Risk of Malignancy in Adenomas Detected During Screening Colonoscopy

Rösch

Altenhofen²,

Kretschmann³

et al. 2018

Clinical Gastroenterology and Hepatology

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“…Research has suggested that molecular, pathological, and clinical features of colorectal neoplasia differ by anatomic location. 40 Sawhney et al 41 found that adenomas with high-grade dysplasia and early adenocarcinoma in the proximal colon were almost four times as likely to be sessile than those in the distal colon, though it has been reported that the prevalence of serrated adenomas was very low (0.9%) in a Chinese population. 15 The usual pathogenesis of colorectal cancer is an adenomatous polyp that slowly increases in size, followed by dysplasia and finally cancer.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and characteristics of colonic adenoma in mainland China

Hong¹,

Dong²,

Stock³

et al. 2018

CMAR

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Background and aimTo investigate the prevalence and characteristics of colonic adenoma and advanced colonic adenoma in a large group of patients in mainland China.Materials and methodsWe conducted a cross-sectional study on patients who had undergone colonoscopy examination in a university hospital in mainland China. Colonic adenomas and advanced adenomas were recorded.ResultsThe prevalence of polyps, adenoma, and advanced adenoma was 23.9%, 13.3%, and 3.5%, respectively. Age and sex were independent risk factors for the prevalence of adenoma and advanced adenoma. Polyp size was associated with an increased risk of both colonic adenoma (OR 1.50, 95% CI 1.44–1.56) and advanced adenoma (OR 2.78, 95% CI 2.55–3.03) after sex and age adjustment. Proximal colon polyps were a risk factor for adenoma (OR 1.41, 95% CI 1.20–1.66) and also associated with a significant reduction (44%) in risk of advanced adenoma (OR 0.56, 95% CI 0.36–0.86) compared to distal colon adenoma after sex and age adjustment. A screening indication was associated with a statistically significant decrease in the odds of prevalence of adenoma (OR 0.90, 95% CI 0.81–0.99) and advanced adenoma (OR 0.72, 95% CI 0.59–0.88) compared to a no-screening indication.ConclusionThe overall prevalence of adenoma was low in mainland China. It exhibited a varied pattern with respect to age and sex. Polyp size was a risk factor for both colonic adenoma and its transition to advanced adenoma. Proximal colon polyps were a risk factor for adenoma, but a protective factor for advanced adenoma compared to distal colon adenoma.

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“…The European guidelines [45] recommended a more aggressive surveillance at 1 year for high risk polyps (≥ 20 mm). In the treatment with piecemeal resection, Walsh et al revealed a rate of 14% polyp recurrence after at least one negative examination, and the rate of CRC development was 17% in 65 patients with large at polyps [46]. A second look examination for patients who underwent piecemeal resection or suspected incomplete resection may be warranted.…”

Section: Discussionmentioning

confidence: 99%

Long Term Outcomes of Colon Polyps with High Grade Dysplasia after Endoscopic Resection

Chang

Chien

Chen

et al. 2020

Preprint

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Abstract Background The clinical characteristics of patients with high-grade dysplasia (HGD) in colon polyps at baseline colonoscopy in relation to the risk of recurrent colonic adenomas have been unclear. We conducted this hospital- based cohort study recruiting patients who had undergone polypectomy at screening colonoscopy to assess the risk factors of recurrent colonic adenomas. Methods 11,565 subjects had undergone screening colonoscopic examinations between September 1998 and August 2007. The patients who had HGD in colon polyps and had undergone surveillance colonoscopy were eligible. Results A total of 211 patients were recruited. The rates of metachronous adenomas and advanced adenomas at surveillance colonoscopy were 58% and 20%, respectively, during the mean follow-up period of 5.5 ± 1.8 (3–12) years. On univariate logistic regression analysis, the number of adenomas ≥ 3 at baseline colonoscopy was strongly associated with the rates of overall recurrence, 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. On multivariate analysis, male gender [P = 0.010; OR 3.09(1.32–7.25 95% CI)] and number of adenomas ≥ 3 [P = 0.002; OR 3.08(1.52–6.24 95%CI)] at index colonoscopy were significantly associated with recurrent advanced adenomas. Conclusions Recurrence of colonic adenomas at surveillance colonoscopy is common in patients who had undergone polypectomy for colon adenomas with HGD at baseline colonoscopy. The risk of developing future advanced adenomas is associated with the number of colon adenomas and male gender.

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Adenomas with high‐grade dysplasia and early adenocarcinoma are more likely to be sessile in the proximal colon

Abstract: APNs in the proximal colon were almost four-times more likely to be sessile than those in the distal colon. No difference in the size of polyps was noted.

Cited by 14 publications

References 21 publications

Risk of Malignancy in Adenomas Detected During Screening Colonoscopy

Risk of Malignancy in Adenomas Detected During Screening Colonoscopy

Prevalence and characteristics of colonic adenoma in mainland China

Long Term Outcomes of Colon Polyps with High Grade Dysplasia after Endoscopic Resection

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