Prevalence of synchronous neoplasia in patients with large pedunculated colorectal polyps

Abstract

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.

Withdrawal time in colonoscopy, past, present, and future, a narrative review

“…In the era of AI, the AI model should be able to combine the baseline risk factors and the real-time data including the difficulty of the procedure and determine the speed of withdrawal and time spent in each segment. For example, studies have shown that finding an adenoma in a segment increases risk of synchronous or metachronous adenomas in the same segment (35)(36)(37). Therefore, finding an adenoma in a segment should lead to a more careful inspection of the same segment, a recommendation that can be reinforced with AI models similar to that used by Liu et al (38).…”

Large pedunculated colorectal polyps: more than meets the eye

“…In this issue of Endoscopy, El Rahyel and colleagues [5] report on the prevalence of synchronous screen-relevant neoplasia among patients with large pedunculated colorectal polyps through a retrospective analysis of a large single-center database of patients referred for endoscopic management of large colorectal polyps. Patients with large nonpedunculated colorectal polyps were used as controls.…”