title: Risk of advanced lesions at the first follow-up colonoscopy after polypectomy of diminutive versus small adenomatous polyps of low-grade dysplasia.
abstract: OBJECTIVE
  The current guidelines for surveillance after polypectomy do not distinguish between diminutive (1-5 mm) and small (6-9 mm) polyps with low-grade dysplasia (LGD). We aimed to evaluate the risk for advanced neoplasia on follow-up colonoscopy.
  
  
  METHODS
  We retrospectively analyzed 443 patients whose worst finding at index colonoscopy was polypectomy of 1 to 5 or 6 to 9 mm polyps with LGD and those who underwent a follow-up colonoscopy.
  
  
  RESULTS
  During a mean follow-up of 32.0 months (interquartile range 13-48 months), advanced neoplasia was found in 26 patients (5.9%). Among all included patients (n = 443), advanced neoplasia was found in 13 of 310 patients (4.2%) of the 1- to 5-mm group versus 13 of 133 patients (9.8%) of the 6- to 9-mm group (hazard ratio [HR], 3.49; 95% confidence interval [CI], 1.6-7.6). Among the patients with 1 to 2 polyps resected (n = 313), advanced neoplasia was found in 8 of 231 patients (3.5%) of the 1- to 5-mm group versus 8 of 82 patients (9.8%) of the 6- to 9-mm group (HR 3.97; 95% CI, 1.47-10.7). Among the patients with ≥3 polyps resected (n = 130), advanced neoplasia was found in 5 of 79 patients (6.3%) of the 1- to 5-mm group versus 5 of 51 patients (9.8%) of the 6- to 9-mm group (HR 2.4; 95% CI, 0.7-8.36). Fair bowel preparation also was associated with the risk for advanced neoplasia at follow-up (HR 3.87, 95% CI, 1.70-8.82).
  
  
  CONCLUSIONS
  Our findings suggest that among patients with up to 9-mm adenomatous polyps, a polyp size of 6 to 9 mm, >2 polyps, and fair bowel preparation are associated with advanced neoplasia.
authors.affiliation: Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Orly
authors.initials: O
authors.lastname: Sneh Arbib
authors.affiliation: Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Valentina
authors.initials: V
authors.lastname: Zemser
authors.affiliation: Department of Internal Medicine D, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yaara
authors.initials: Y
authors.lastname: Leibovici Weissman
authors.affiliation: Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gingold-Belfer
authors.affiliation: Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Vilkin
authors.affiliation: Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Sapir
authors.initials: S
authors.lastname: Eizenstein
authors.affiliation: Department of Quality Measures and Research, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Department of Quality Measures and Research, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Comaneshter
authors.affiliation: Statistics Service, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Shochat
authors.initials: S
authors.lastname: Tzipora
authors.affiliation: Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Niv
authors.affiliation: Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Yeuda
authors.initials: Y
authors.lastname: Ringel
authors.affiliation: Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: David
authors.initials: D
authors.lastname: Lieberman
authors.affiliation: Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Zohar
authors.initials: Z
authors.lastname: Levi
mesh_terms: D018256:Adenomatous Polyps / Q000473:pathology / Q000601:surgery*; D000359:Aftercare; D000368:Aged; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D047368:Tumor Burden