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A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.
A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.
- Source :
-
Gastroenterology [Gastroenterology] 2009 Mar; Vol. 136 (3), pp. 832-41. Date of Electronic Publication: 2008 Dec 09. - Publication Year :
- 2009
-
Abstract
- Background & Aims: Limited data exist regarding the actual risk of developing advanced adenomas and cancer after polypectomy or the factors that determine risk.<br />Methods: We pooled individual data from 8 prospective studies comprising 9167 men and women aged 22 to 80 with previously resected colorectal adenomas to quantify their risk of developing subsequent advanced adenoma or cancer as well as identify factors associated with the development of advanced colorectal neoplasms during surveillance.<br />Results: During a median follow-up period of 47.2 months, advanced colorectal neoplasia was diagnosed in 1082 (11.8%) of the patients, 58 of whom (0.6%) had invasive cancer. Risk of a metachronous advanced adenoma was higher among patients with 5 or more baseline adenomas (24.1%; standard error, 2.2) and those with an adenoma 20 mm in size or greater (19.3%; standard error, 1.5). Risk factor patterns were similar for advanced adenomas and invasive cancer. In multivariate analyses, older age (P < .0001 for trend) and male sex (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.19-1.65) were associated significantly with an increased risk for metachronous advanced neoplasia, as were the number and size of prior adenomas (P < .0001 for trend), the presence of villous features (OR, 1.28; 95% CI, 1.07-1.52), and proximal location (OR, 1.68; 95% CI, 1.43-1.98). High-grade dysplasia was not associated independently with metachronous advanced neoplasia after adjustment for other adenoma characteristics.<br />Conclusions: Occurrence of advanced colorectal neoplasia is common after polypectomy. Factors that are associated most strongly with risk of advanced neoplasia are patient age and the number and size of prior adenomas.
- Subjects :
- Adenoma surgery
Adult
Age Distribution
Aged
Aged, 80 and over
Colonic Polyps surgery
Colonoscopy
Colorectal Neoplasms surgery
Female
Follow-Up Studies
Humans
Male
Middle Aged
Odds Ratio
Prospective Studies
Risk Factors
Severity of Illness Index
Sex Distribution
Young Adult
Adenoma epidemiology
Adenoma pathology
Colonic Polyps epidemiology
Colonic Polyps pathology
Colorectal Neoplasms epidemiology
Colorectal Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0012
- Volume :
- 136
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 19171141
- Full Text :
- https://doi.org/10.1053/j.gastro.2008.12.007