Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
Dig Endosc. 2022 May;34(4):850-857. doi: 10.1111/den.14159. Epub 2021 Oct 26.
Post-polypectomy surveillance intervals should be determined based on index colonoscopy findings. However, the risk of metachronous lesions, resulting from the coexistence of adenoma and sessile serrated lesions (SSLs), has rarely been addressed. We evaluated the impact of synchronous SSL on the risk of metachronous lesions within similar adenoma risk groups.
We retrieved individuals with one or more adenomas on index colonoscopy in a single-center retrospective cohort and stratified them into four groups depending on the presence of SSL and low-risk/high-risk adenoma (LRA/HRA). Participants who underwent surveillance colonoscopies at least 12 months apart were included. We compared the risks of metachronous lesions including HRA, advanced adenoma (AA), or SSL within similar adenoma risk groups according to the presence of SSL.
Overall 4493 individuals were included in the analysis. The risk of metachronous HRA/AA was not significantly higher in the adenoma with SSL group compared with the adenoma without SSL group, irrespective of LRA (HRA, 6/86 vs. 231/3297, P = 1.00; AA, 0/86 vs. 52/3297, P = 0.64) or HRA (HRA, 11/64 vs. 240/1046, P = 0.36; AA, 3/64 vs. 51/1046, P = 1.00). However, the risk of metachronous SSL in individuals with synchronous SSL was higher than that in those without SSL for both LRA (15/86 vs. 161/3297, P < 0.001) and HRA groups (11/64 vs. 61/1046, P = 0.002).
The presence of synchronous SSL did not increase the risk of metachronous HRA/AA, compared with isolated adenoma, but increased the risk of metachronous SSL.
基于结肠镜检查结果确定息肉切除术后的监测间隔时间。然而，腺瘤和无蒂锯齿状病变（SSL）共存导致的异时性病变风险很少被提及。我们评估了同步 SSL 对相似腺瘤风险组内异时性病变风险的影响。
我们从单中心回顾性队列中检索出在结肠镜检查中存在一个或多个腺瘤的个体，并根据 SSL 和低危/高危腺瘤（LRA/HRA）的存在将他们分为四组。包括至少相隔 12 个月进行监测结肠镜检查的参与者。我们比较了根据 SSL 存在情况，在具有相似腺瘤风险的组中，HRA、高级别腺瘤（AA）或 SSL 的异时性病变风险。
共有 4493 人纳入分析。与无 SSL 的腺瘤组相比，具有 SSL 的腺瘤组的异时性 HRA/AA 风险并没有显著增加，无论 LRA 如何（HRA，6/86 比 231/3297，P=1.00；AA，0/86 比 52/3297，P=0.64）或 HRA（HRA，11/64 比 240/1046，P=0.36；AA，3/64 比 51/1046，P=1.00）。然而，在同步 SSL 的个体中，异时性 SSL 的风险高于无 SSL 的个体，无论是在 LRA（15/86 比 161/3297，P<0.001）还是 HRA 组（11/64 比 61/1046，P=0.002）。
与孤立腺瘤相比，同步 SSL 的存在并未增加异时性 HRA/AA 的风险，但增加了异时性 SSL 的风险。
