Endoscopic and histopathologic predictors of recurrence of colorectal adenoma on lowering the miss rate.
OBJECTIVE
Although colorectal adenoma is reported to recur frequently, this may result from missing it at baseline. However, few studies of recurrence have considered the miss rate. This study evaluated the recurrence rate prospectively and clinical predictors of recurrence in colorectal adenoma after lowering the miss rate.


METHODS
The study population comprised 128 patients who underwent baseline colonoscopy with resection of colorectal adenomas. Re-examination to lower the miss rate was performed within 2 months. Follow-up colonoscopy to detect recurrence was done more than 1 year after removal.


RESULTS
The mean follow-up period was 35.1 months (range, 12 to 84 months). Thirty patients had a recurrent adenoma, for a recurrence rate of 23.4%. Older patients (over 60 years) had a two-fold greater risk of recurrence than younger patients (hazard ratio, 2.39; 95% confidence interval [CI], 1.16-4.90). Patients with three or four adenomas at baseline colonoscopy had a two-fold greater risk than those with one adenoma (hazard ratio, 2.44; 95% CI, 1.11-5.35). Patients with advanced adenoma had a two-fold greater risk than those with no advanced adenoma (hazard ratio, 2.88; 95% CI, 1.40-5.95). In multivariate analysis, only the presence of three or four adenomas independently predicted the recurrence of adenoma (hazard ratio, 3.19; 95% CI, 1.04-9.79).


CONCLUSIONS
The recurrence rate of colorectal adenoma corrected by lowering the miss rate was lower than reported rates. The presence of multiple adenomas on initial colonoscopy was an important predictor of recurrence.
Ji
Jeong-Seon
JS
Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
Choi
Kyu-Yong
KY
Lee
Won-Chul
WC
Lee
Bo-In
BI
Park
Soo-Heon
SH
Choi
Hwang
H
Kim
Byung-Wook
BW
Chae
Hiun-Suk
HS
Park
Yong-Moon
YM
Park
Young-Jun
YJ
D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000473:pathology