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


METHODS
A retrospective study.


METHODS
A tertiary-referral center.


METHODS
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.


METHODS
"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).


CONCLUSIONS
A retrospective design.


CONCLUSIONS
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.
Khashab
Mouen
M
Division of Gastroenterology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
Eid
Emely
E
Rusche
Michael
M
Rex
Douglas K
DK
D018256:Adenomatous Polyps / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors