Incidence and predictors of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas

Mouen Khashab, Emely Eid, Michael Rusche, Douglas Rex

Research output: Contribution to journalArticle

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Abstract

Background: Large sessile colorectal adenomas (≥2 cm in size) resected piecemeal have a 0% to 55% rate of residual adenoma at the first follow-up. Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent "late" recurrence. Objective: Our aim was to describe long-term follow-up of large sessile adenomas after piecemeal resection and to report the incidence and predictors of "late" recurrence. Design: A retrospective study. Setting: A tertiary-referral center. Patients and Interventions: Large sessile colorectal adenomas were identified through an endoscopic database. Polyps were resected by piecemeal technique; flat areas that could not be snared were treated with argon plasma coagulation. Patients who completed follow-up examinations at our center 3 to 6 months and at least 1 year after initial resection were included. Main Outcome Measurements: "Late" adenoma recurrence. Results: Of 136 polyps with complete follow-up, 24 (17.6%) had macroscopically evident residual adenoma at follow-up, including 18 at the first follow-up and 6 (4.4%) with a "late" recurrence. Among 94 polyps with no visible adenoma and with negative biopsy specimens of the scar at the first follow-up, 92 polyps (97.9%) were eradicated at late follow-up, compared with 36 of 42 (85.7%) of the remaining polyps (P = .005). Limitation: A retrospective design. Conclusion: Our results confirm the phenomenon of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas. However, a normal macroscopic appearance of the polypectomy site and negative scar biopsy specimens at the first follow-up is predictive of long-term eradication.

Original languageEnglish
Pages (from-to)344-349
Number of pages6
JournalGastrointestinal Endoscopy
Volume70
Issue number2
DOIs
StatePublished - Aug 2009

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Adenoma
Recurrence
Polyps
Incidence
Cicatrix
Argon Plasma Coagulation
Biopsy
Tertiary Care Centers
Retrospective Studies
Databases
Guidelines

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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Incidence and predictors of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas. / Khashab, Mouen; Eid, Emely; Rusche, Michael; Rex, Douglas.

In: Gastrointestinal Endoscopy, Vol. 70, No. 2, 08.2009, p. 344-349.

Research output: Contribution to journalArticle

Khashab, Mouen ; Eid, Emely ; Rusche, Michael ; Rex, Douglas. / Incidence and predictors of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas. In: Gastrointestinal Endoscopy. 2009 ; Vol. 70, No. 2. pp. 344-349.
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abstract = "Background: Large sessile colorectal adenomas (≥2 cm in size) resected piecemeal have a 0{\%} to 55{\%} rate of residual adenoma at the first follow-up. Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent {"}late{"} recurrence. Objective: Our aim was to describe long-term follow-up of large sessile adenomas after piecemeal resection and to report the incidence and predictors of {"}late{"} recurrence. Design: A retrospective study. Setting: A tertiary-referral center. Patients and Interventions: Large sessile colorectal adenomas were identified through an endoscopic database. Polyps were resected by piecemeal technique; flat areas that could not be snared were treated with argon plasma coagulation. Patients who completed follow-up examinations at our center 3 to 6 months and at least 1 year after initial resection were included. Main Outcome Measurements: {"}Late{"} adenoma recurrence. Results: Of 136 polyps with complete follow-up, 24 (17.6{\%}) had macroscopically evident residual adenoma at follow-up, including 18 at the first follow-up and 6 (4.4{\%}) with a {"}late{"} recurrence. Among 94 polyps with no visible adenoma and with negative biopsy specimens of the scar at the first follow-up, 92 polyps (97.9{\%}) were eradicated at late follow-up, compared with 36 of 42 (85.7{\%}) of the remaining polyps (P = .005). Limitation: A retrospective design. Conclusion: Our results confirm the phenomenon of {"}late{"} recurrences after endoscopic piecemeal resection of large sessile adenomas. However, a normal macroscopic appearance of the polypectomy site and negative scar biopsy specimens at the first follow-up is predictive of long-term eradication.",
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N2 - Background: Large sessile colorectal adenomas (≥2 cm in size) resected piecemeal have a 0% to 55% rate of residual adenoma at the first follow-up. Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent "late" recurrence. Objective: Our aim was to describe long-term follow-up of large sessile adenomas after piecemeal resection and to report the incidence and predictors of "late" recurrence. Design: A retrospective study. Setting: A tertiary-referral center. Patients and Interventions: Large sessile colorectal adenomas were identified through an endoscopic database. Polyps were resected by piecemeal technique; flat areas that could not be snared were treated with argon plasma coagulation. Patients who completed follow-up examinations at our center 3 to 6 months and at least 1 year after initial resection were included. Main Outcome Measurements: "Late" adenoma recurrence. Results: Of 136 polyps with complete follow-up, 24 (17.6%) had macroscopically evident residual adenoma at follow-up, including 18 at the first follow-up and 6 (4.4%) with a "late" recurrence. Among 94 polyps with no visible adenoma and with negative biopsy specimens of the scar at the first follow-up, 92 polyps (97.9%) were eradicated at late follow-up, compared with 36 of 42 (85.7%) of the remaining polyps (P = .005). Limitation: A retrospective design. Conclusion: Our results confirm the phenomenon of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas. However, a normal macroscopic appearance of the polypectomy site and negative scar biopsy specimens at the first follow-up is predictive of long-term eradication.

AB - Background: Large sessile colorectal adenomas (≥2 cm in size) resected piecemeal have a 0% to 55% rate of residual adenoma at the first follow-up. Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent "late" recurrence. Objective: Our aim was to describe long-term follow-up of large sessile adenomas after piecemeal resection and to report the incidence and predictors of "late" recurrence. Design: A retrospective study. Setting: A tertiary-referral center. Patients and Interventions: Large sessile colorectal adenomas were identified through an endoscopic database. Polyps were resected by piecemeal technique; flat areas that could not be snared were treated with argon plasma coagulation. Patients who completed follow-up examinations at our center 3 to 6 months and at least 1 year after initial resection were included. Main Outcome Measurements: "Late" adenoma recurrence. Results: Of 136 polyps with complete follow-up, 24 (17.6%) had macroscopically evident residual adenoma at follow-up, including 18 at the first follow-up and 6 (4.4%) with a "late" recurrence. Among 94 polyps with no visible adenoma and with negative biopsy specimens of the scar at the first follow-up, 92 polyps (97.9%) were eradicated at late follow-up, compared with 36 of 42 (85.7%) of the remaining polyps (P = .005). Limitation: A retrospective design. Conclusion: Our results confirm the phenomenon of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas. However, a normal macroscopic appearance of the polypectomy site and negative scar biopsy specimens at the first follow-up is predictive of long-term eradication.

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