Jasper L A Vleugels1, Cesare Hassan2, Carlo Senore3, Paola Cassoni4, John A Baron5, Douglas K Rex6, Prasanna L Ponugoti6, Maria Pellise7, Sofia Parejo8, Xavier Bessa9, Coral Arnau-Collell7, Michal F Kaminski10, Marek Bugajski11, Paulina Wieszczy12, Ernst J Kuipers13, Joshua Melson14, Karen H Ma14, Rebecca Holman15, Evelien Dekker1, Heiko Pohl16. 1. Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands. 2. Department of Gastroenterology and Hepatology, Humanitas Research Hospital, Humanitas University, Milan, Italy. 3. Epidemiology and screening Unit - CPO, University Hospital Città della Salute e della Scienza, Turin, Italy. 4. Department of Medical Science, Pathology unit, University of Turin, Turin, Italy. 5. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 6. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana. 7. Department of Gastroenterology, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 8. Department of Gastroenterology, Hospital Ramón y Cajal, Madrid, Spain. 9. Gastroenterology Department, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. 10. Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland; Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland; Department of Cancer Prevention, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. 11. Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland; Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland. 12. Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland; Department of Cancer Prevention, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. 13. Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands. 14. Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois. 15. Clinical Research Unit, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands. 16. Department of Gastroenterology, Veterans Affairs Medical Center, White River Junction, Vermont. Electronic address: heiko.pohl@dartmouth.edu.
Abstract
BACKGROUND & AIMS: With advances in endoscopic imaging, it is possible to differentiate adenomatous from hyperplastic diminutive (1-5 mm) polyps during endoscopy. With the optical Resect-and-Discard strategy, these polyps are then removed and discarded without histopathology assessment. However, failure to recognize adenomas (vs hyperplastic polyps), or discarding a polyp with advanced histologic features, could result in a patient being considered at low risk for metachronous advanced neoplasia, resulting in an inappropriately long surveillance interval. We collected data from international cohorts of patients undergoing colonoscopy to determine what proportion of patients are high risk because of diminutive polyps advanced histologic features and their risk for metachronous advanced neoplasia. METHODS: We collected data from 12 cohorts (in the United States or Europe) of patients undergoing colonoscopy after a positive result from a fecal immunochemical test (FIT cohort, n = 34,221) or undergoing colonoscopies for screening, surveillance, or evaluation of symptoms (colonoscopy cohort, n = 30,123). Patients at high risk for metachronous advanced neoplasia were defined as patients with polyps that had advanced histologic features (cancer, high-grade dysplasia, ≥25% villous features), 3 or more diminutive or small (6-9 mm) nonadvanced adenomas, or an adenoma or sessile serrated lesion ≥10 mm. Using an inverse variance random effects model, we calculated the proportion of diminutive polyps with advanced histologic features; the proportion of patients classified as high risk because their diminutive polyps had advanced histologic features; and the risk of these patients for metachronous advanced neoplasia. RESULTS: In 51,510 diminutive polyps, advanced histologic features were observed in 7.1% of polyps from the FIT cohort and 1.5% polyps from the colonoscopy cohort (P = .044); however, this difference in prevalence did not produce a significant difference in the proportions of patients assigned to high-risk status (0.8% of patients in the FIT cohort and 0.4% of patients in the colonoscopy cohort) (P = .25). The proportions of high-risk patients because of diminutive polyps with advanced histologic features who were found to have metachronous advanced neoplasia (17.6%) did not differ significantly from the proportion of low-risk patients with metachronous advanced neoplasia (14.6%) (relative risk for high-risk categorization, 1.13; 95% confidence interval 0.79-1.61). CONCLUSION: In a pooled analysis of data from 12 international cohorts of patients undergoing colonoscopy for screening, surveillance, or evaluation of symptoms, we found that diminutive polyps with advanced histologic features do not increase risk for metachronous advanced neoplasia.
BACKGROUND & AIMS: With advances in endoscopic imaging, it is possible to differentiate adenomatous from hyperplastic diminutive (1-5 mm) polyps during endoscopy. With the optical Resect-and-Discard strategy, these polyps are then removed and discarded without histopathology assessment. However, failure to recognize adenomas (vs hyperplastic polyps), or discarding a polyp with advanced histologic features, could result in a patient being considered at low risk for metachronous advanced neoplasia, resulting in an inappropriately long surveillance interval. We collected data from international cohorts of patients undergoing colonoscopy to determine what proportion of patients are high risk because of diminutive polyps advanced histologic features and their risk for metachronous advanced neoplasia. METHODS: We collected data from 12 cohorts (in the United States or Europe) of patients undergoing colonoscopy after a positive result from a fecal immunochemical test (FIT cohort, n = 34,221) or undergoing colonoscopies for screening, surveillance, or evaluation of symptoms (colonoscopy cohort, n = 30,123). Patients at high risk for metachronous advanced neoplasia were defined as patients with polyps that had advanced histologic features (cancer, high-grade dysplasia, ≥25% villous features), 3 or more diminutive or small (6-9 mm) nonadvanced adenomas, or an adenoma or sessile serrated lesion ≥10 mm. Using an inverse variance random effects model, we calculated the proportion of diminutive polyps with advanced histologic features; the proportion of patients classified as high risk because their diminutive polyps had advanced histologic features; and the risk of these patients for metachronous advanced neoplasia. RESULTS: In 51,510 diminutive polyps, advanced histologic features were observed in 7.1% of polyps from the FIT cohort and 1.5% polyps from the colonoscopy cohort (P = .044); however, this difference in prevalence did not produce a significant difference in the proportions of patients assigned to high-risk status (0.8% of patients in the FIT cohort and 0.4% of patients in the colonoscopy cohort) (P = .25). The proportions of high-risk patients because of diminutive polyps with advanced histologic features who were found to have metachronous advanced neoplasia (17.6%) did not differ significantly from the proportion of low-risk patients with metachronous advanced neoplasia (14.6%) (relative risk for high-risk categorization, 1.13; 95% confidence interval 0.79-1.61). CONCLUSION: In a pooled analysis of data from 12 international cohorts of patients undergoing colonoscopy for screening, surveillance, or evaluation of symptoms, we found that diminutive polyps with advanced histologic features do not increase risk for metachronous advanced neoplasia.
Authors: Matthew D Rutter; James East; Colin J Rees; Neil Cripps; James Docherty; Sunil Dolwani; Philip V Kaye; Kevin J Monahan; Marco R Novelli; Andrew Plumb; Brian P Saunders; Siwan Thomas-Gibson; Damian J M Tolan; Sophie Whyte; Stewart Bonnington; Alison Scope; Ruth Wong; Barbara Hibbert; John Marsh; Billie Moores; Amanda Cross; Linda Sharp Journal: Gut Date: 2019-11-27 Impact factor: 31.793
Authors: Philippe Willems; Roupen Djinbachian; Saskia Ditisheim; Sinan Orkut; Heiko Pohl; Alan Barkun; Mickael Bouin; Bernard Faulques; Daniel von Renteln Journal: Endosc Int Open Date: 2020-04-17