title: Incidence and predictors of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas.
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.
  
  
  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.
authors.affiliation: Division of Gastroenterology, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
authors.forename: Mouen
authors.initials: M
authors.lastname: Khashab
authors.forename: Emely
authors.initials: E
authors.lastname: Eid
authors.forename: Michael
authors.initials: M
authors.lastname: Rusche
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: 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