Increased Risk of Synchronous Colorectal Lesions in Patients Referred for Endoscopic Mucosal Resection of Lateral Spreading Tumors

Torella, Maria Constanza; Duarte, Belen; Villarroel, Mariano; Lasa, Juan S.; Zubiaurre, Ignacio

doi:10.1590/s0004-2803.201900000-52

Cited by 3 publications

(7 citation statements)

References 21 publications

(21 reference statements)

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“…Cohorts of LSTs show high numbers of synchronous CRNs in patients with NP-CRNs and LSTs. 12,13,22,23 Our findings confirm and expand on these data in comparison with polypoid neoplasms of comparable size. In a cohort of LST patients, synchronous CRNs were common among patients with large LSTs.…”

Section: Discussionsupporting

confidence: 88%

“…Patients with NP‐CRNs more often had advanced neoplasms at baseline (63% vs. 25%) and were more often diagnosed with advanced neoplasms (relative risk 1.6, 95% CI 1.05–2.6) during the first surveillance colonoscopy than patients with polypoid CRNs. Cohorts of LSTs show high numbers of synchronous CRNs in patients with NP‐CRNs and LSTs 12,13,22,23 . Our findings confirm and expand on these data in comparison with polypoid neoplasms of comparable size.…”

Section: Discussionsupporting

confidence: 86%

“…Previous studies have shown that patients with LSTs have a higher risk of synchronous neoplasms 12,13 . This finding could affect the surveillance strategy for LST patients.…”

Section: Introductionmentioning

confidence: 99%

“…11 Previous studies have shown that patients with LSTs have a higher risk of synchronous neoplasms. 12,13 This finding could affect the surveillance strategy for LST patients. At our academic endoscopy unit, we examined the prevalence of LSTs, endoscopic subtypes and histology in our prospective colonoscopy database.…”

Section: Introductionmentioning

confidence: 99%

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Metachronous neoplasms in patients with laterally spreading tumours during surveillance

Bogie

Winkens

Retra

et al. 2021

United European Gastroenterol. j.

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Background Laterally spreading tumours represent a major challenge for endoscopic detection and resection. Objective To examine synchronous and metachronous neoplasms in patients with laterally spreading tumours. Methods We prospectively collected colonoscopy and histopathology data from patients who underwent colonoscopy in our centre at up to 6 years’ follow-up. Post-resection surveillance outcomes between laterally spreading tumours, flat colorectal neoplasms 10 mm or greater, and large polypoid colorectal neoplasms, polypoid colorectal neoplasms 10 mm or greater, were compared. Results Between 2008 and 2012, 8120 patients underwent colonoscopy for symptoms (84.6%), screening (6.7%) or surveillance (8.7%). At baseline, 151 patients had adenomatous laterally spreading tumours and 566 patients had adenomatous large polypoid colorectal neoplasms. Laterally spreading tumour patients had more synchronous colorectal neoplasms than large polypoid colorectal neoplasm patients (mean 3.34 vs. 2.34, P < 0.001). Laterally spreading tumour patients significantly more often developed metachronous colorectal neoplasms (71.6% vs. 54.2%, P = 0.0498) and colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients (36.4% vs. 15.8%, P < 0.001). After correction for age and gender, laterally spreading tumour patients were more likely than large polypoid colorectal neoplasm patients to develop a colorectal neoplasm with high grade dysplasia or submucosal invasion (hazard ratio 2.9, 95% confidence interval 1.8–4.6). The risk of metachronous colorectal cancer was not significantly different in laterally spreading tumours compared to large polypoid colorectal neoplasm patients. Conclusion Patients with laterally spreading tumours developed more metachronous colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients. Based on these findings endoscopic treatment and surveillance recommendations for patients with laterally spreading tumours should be optimised.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 86%

“…Previous studies have shown that patients with LSTs have a higher risk of synchronous neoplasms 12,13 . This finding could affect the surveillance strategy for LST patients.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Metachronous neoplasms in patients with laterally spreading tumours during surveillance

Bogie

Winkens

Retra

et al. 2021

United European Gastroenterol. j.

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“…Furthermore, this high prevalence is comparable to or higher than patients with ≥ 20 mm nonpedunculated lesions, for every category of synchronous polyp by size and histology ( Table 3 ). Thus, patients with large pedunculated colorectal polyps warrant careful clearing of the colon for synchronous disease, similarly to patients with large (≥ 20 mm) nonpedunculated index lesions 1 2 3 . The high rate of synchronous disease described here for patients with large pedunculated polyps was identified despite only a fraction of these patients having a first surveillance examination at our center, compared with all the patients with nonpedunculated lesions.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of synchronous neoplasia in patients with large pedunculated colorectal polyps

2022

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Background and study aims: Large (≥ 20 mm) non-pedunculated colorectal lesions have high rates of synchronous neoplasia and advanced neoplasia. Synchronous neoplasia prevalence in patients with large pedunculated lesions is uncertain. We describe synchronous neoplasia in patients with large pedunculated colorectal polyps, using a cohort of patients with large non-pedunculated lesions as controls. Patients and methods: Retrospective assessment of a prospectively recorded database listing synchronous findings in patients with ≥ 20 mm colorectal lesions referred to a tertiary center for endoscopic resection. Results: At least 1 synchronous precancerous lesion was identified in 66 of 78 (84.6%, 95% CI 74.9-91.1) patients with large pedunculated lesions and 726 of 814 (89.2%, 95% CI 87.1-91.3) patients with large non-pedunculated lesions. Patients with large pedunculated lesions had mean 4.8 synchronous conventional adenomas, and 56% had ≥ 1 synchronous high-risk lesion (advanced adenoma or advanced serrated lesion), 49% had ≥ 1 synchronous advanced conventional adenoma, and 19% had a synchronous neoplastic lesion ≥ 20 mm. Patients with large pedunculated index lesions had comparable rates of synchronous polyps, adenomas, and sessile serrated lesions, and had higher rates of synchronous adenomas with villous elements (26.9%, 95% CI 18.3-37.7 vs. 15.6%, 95% CI 13.3-18.3; p = 0.01) as well as synchronous pedunculated polyps compared to patients with non-pedunculated index lesions (33.3%, 95% CI 23.8-44.4 vs. 9.5%, 95% CI 7.6-11.7; p < 0.001). Conclusion: In patients with large (≥ 20 mm) pedunculated colorectal lesions, rates of synchronous neoplasia and advanced synchronous neoplasia are high and comparable to or higher than rates of synchronous neoplasia in patients with large (≥ 20 mm) nonpedunculated colorectal lesions.

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Increased Risk of Synchronous Colorectal Lesions in Patients Referred for Endoscopic Mucosal Resection of Lateral Spreading Tumors

Cited by 3 publications

References 21 publications

Metachronous neoplasms in patients with laterally spreading tumours during surveillance

Metachronous neoplasms in patients with laterally spreading tumours during surveillance

Prevalence of synchronous neoplasia in patients with large pedunculated colorectal polyps

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