Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Gastrointest Endosc. 2020 Mar;91(3):622-630. doi: 10.1016/j.gie.2019.09.044. Epub 2019 Oct 22.
Current postpolypectomy guidelines classify 1 to 2 diminutive (1-5 mm) nonadvanced adenomas (NAAs) and 1 to 2 small (6-9 mm) NAAs as low-risk adenomas and recommend the same surveillance interval for both lesions. We compared the risk of metachronous advanced colorectal neoplasia (ACRN) for both groups.
We studied 8602 patients who underwent removal of ≥1 NAA and follow-up colonoscopic surveillance. Patients were categorized into 4 groups based on size and number of baseline NAAs: group 1, ≤2 diminutive NAAs (n = 6379); group 2, ≤2 small NAAs (n = 1672); group 3, ≥3 diminutive NAAs (n = 293); and group 4, ≥3 small NAAs (n = 258). Size was classified based on the largest NAA.
The 5-year cumulative incidence rates of metachronous ACRN in groups 1, 2, 3, and 4 were 2.7%, 5.1%, 10.7%, and 15.1%, respectively. Groups 2, 3, and 4 had a higher risk of metachronous ACRN than group 1. Compared with group 1, the adjusted hazard ratios for metachronous ACRN were 2.06 (95% confidence interval [CI], 1.46-2.91) for group 2, 2.75 (95% CI, 1.53-4.96) for group 3, and 4.49 (95% CI, 2.62-7.70) for group 4. However, the risk of metachronous ACRN was not significantly different between groups 3 and 4 (adjusted hazard ratio, 1.62; 95% CI, .76-3.44).
Among patients with ≤2 NAAs, patients with 1- to 5-mm NAAs had a lower risk of metachronous ACRN than those with 6- to 9-mm NAAs. The guidelines should consider extending surveillance intervals in patients with ≤2 diminutive NAAs.
目前的息肉切除后指南将 1-2 个微小（1-5 毫米）非高级腺瘤（NAA）和 1-2 个小（6-9 毫米）NAA 归类为低风险腺瘤，并建议对这两种病变进行相同的监测间隔。我们比较了两组患者发生异时性高级结直肠肿瘤（ACRN）的风险。
我们研究了 8602 名接受至少 1 个 NAA 切除和随访结肠镜监测的患者。根据基线 NAA 的大小和数量，患者被分为 4 组：组 1，≤2 个微小 NAA（n=6379）；组 2，≤2 个小 NAA（n=1672）；组 3，≥3 个微小 NAA（n=293）；组 4，≥3 个小 NAA（n=258）。大小基于最大的 NAA 进行分类。
组 1、2、3 和 4 患者的 5 年异时性 ACRN 累积发生率分别为 2.7%、5.1%、10.7%和 15.1%。组 2、3 和 4 发生异时性 ACRN 的风险高于组 1。与组 1 相比，组 2、3 和 4 发生异时性 ACRN 的调整后危险比分别为 2.06（95%置信区间[CI]，1.46-2.91）、2.75（95% CI，1.53-4.96）和 4.49（95% CI，2.62-7.70）。然而，组 3 和 4 之间异时性 ACRN 的风险无显著差异（调整后危险比，1.62；95%CI，.76-3.44）。
在≤2 个 NAA 的患者中，1-5 毫米 NAA 的患者发生异时性 ACRN 的风险低于 6-9 毫米 NAA 的患者。指南应考虑延长≤2 个微小 NAA 患者的监测间隔。
