Dai Min, Xiao Xiang, Guo Cosmos L T, Lui Rashid N, Yip Hon Chi, Chu Simon, Hon Sok Fei, Ng Simon S M, Chiu Philip W Y, Ng Siew C, Chan Francis K L, Lau Louis H S
Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
United European Gastroenterol J. 2025 Mar;13(2):210-219. doi: 10.1002/ueg2.12735. Epub 2024 Dec 21.
Long-term data on metachronous advanced adenoma (AA) recurrence after endoscopic submucosal dissection (ESD) remain scarce, leading to a lack of a standardized surveillance strategy. This study aims to evaluate the long-term risk of recurrent AA after ESD.
A longitudinal retrospective cohort study with propensity-score matching was conducted in a tertiary hospital in Hong Kong. Subjects who underwent colorectal ESD between 2011 and 2017 were enrolled and defined as the post-ESD group. Selected subjects who underwent polypectomy in their index colonoscopy between 2011 and 2017 were enrolled and stratified into the low- intermediate- and the high-risk groups according to the US Multi-Society Task Force (USMSTF) guideline. The risks of recurrent AA were assessed by Cox proportional hazards regression in the matched cohorts.
A total of 1745 subjects were included, with 203 post-ESD subjects fully matched with 729 high-risk and 813 low-intermediate-risk subjects, respectively. The 5-year cumulative incidence of recurrent AA in the post-ESD group was 7.8%. After 5 years, the post-ESD group was not associated with a higher rate of recurrent AA to the low-intermediate-risk group (7.8% vs. 5.5%; adjusted HR [aHR] 1.64, 95% CI 0.77-3.48, p = 0.197) but a lower rate of recurrent AA (7.8% vs. 11.8%; aHR 0.40, 95% CI 0.19-0.85, p = 0.017) than the high-risk group.
Subjects who underwent ESD were not associated with an increased 5-year risk of metachronous AA recurrence than low-intermediate or high-risk groups in USMSTF. The findings will inform future guidelines on post-ESD surveillance colonoscopy strategies.
关于内镜黏膜下剥离术（ESD）后异时性进展性腺瘤（AA）复发的长期数据仍然稀缺，导致缺乏标准化的监测策略。本研究旨在评估ESD后AA复发的长期风险。
在香港一家三级医院进行了一项倾向评分匹配的纵向回顾性队列研究。纳入2011年至2017年间接受结直肠ESD的受试者，并将其定义为ESD后组。选取2011年至2017年间在其初次结肠镜检查时接受息肉切除术的受试者，并根据美国多学会工作组（USMSTF）指南将其分层为低、中、高风险组。通过Cox比例风险回归评估匹配队列中AA复发的风险。
共纳入1745名受试者，其中203名ESD后受试者分别与729名高风险和813名低-中风险受试者完全匹配。ESD后组AA复发的5年累积发病率为7.8%。5年后，ESD后组与低-中风险组相比，AA复发率没有更高（7.8%对5.5%；调整后风险比[aHR]为1.64，95%置信区间为0.77-3.48，p = 0.197），但与高风险组相比，AA复发率较低（7.8%对11.8%；aHR为0.40，95%置信区间为0.19-0.85，p = 0.017）。
与USMSTF定义的低-中风险或高风险组相比，接受ESD的受试者5年内异时性AA复发风险并未增加。这些发现将为未来ESD后监测结肠镜检查策略的指南提供参考。
