Small Tubular Adenomas Plus Small Serrated Polyps Equals Higher Risk of Metachronous Advanced Neoplasms

Small Tubular Adenomas Plus Small Serrated Polyps Equals Higher Risk of Metachronous Advanced Neoplasms

Douglas K. Rex, MD, MASGE, reviewing Hamoudah T, et al. Gastrointest Endosc 2022 Feb 17.

Recent studies have added complexity to our understanding of postpolypectomy surveillance risk, such as the risk of metachronous advanced neoplasia is higher with 6- to 9-mm baseline adenomas than 1- to 5-mm baseline adenomas. A common scenario in clinical practice is for patients to have both small (<1 cm) conventional adenomas and concurrent serrated polyps (SPs; defined as either small sessile serrated lesions [SSLs] or small hyperplastic polyps [HPs]).

This study looked at the risk of metachronous advanced neoplasia, defined as either advanced conventional adenomas or advanced serrated lesions (serrated polyps [SPs] ≥10 mm or with cytological dysplasia) at follow-up.

In a two-center U.S. study, 1389 patients had either isolated small tubular adenomas (TAs; 82% of the group) or TAs plus SPs (18% of the group: 15.3% had an HP as their SP, and 2.8% had an SSL).

The risk of any metachronous advanced neoplasia was 5.2% in the group with isolated, small TAs, 9% in those with TAs plus small HPs, and 12.8% in patients with TAs plus small SSLs.

The additional metachronous advanced neoplasia created by the group with both TAs and SPs was accounted for by more advanced SPs at follow-up. There were no metachronous cancers at follow-up.

Douglas K. Rex, MD, FASGE

COMMENT

Currently, the U.S. Multi-Society Task Force on Colorectal Cancer (MSTF) recommends that patients with 1 or 2 TAs <10 mm in size undergo their next surveillance colonoscopy at 7 to 10 years. Based on recent evidence, I have usually chosen 7 years as the interval if one of the TAs is 6 to 9 mm in size and 10 years if the TAs are ≤5 mm. Based on these data, 7 years could also be appropriate for the group with 1 or 2 small TAs and 1 or 2 small HPs. The MSTF guideline recommends 5- to 10-year surveillance intervals for patients with 1 or small SSLs in any case, and many endoscopists will likely choose 5 years for a small or diminutive SSL. In the case of small TAs and small SSLs, I usually treat them all the same with regard to risk and will choose 3 to 5 years for follow-up in patients with 3 to 4 lesions that are combinations of small TAs and SSLs, depending on their size.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Hamoudah T, Vemulapalli KC, Alsayid M, et al. Risk of total metachronous advanced neoplasia in patients with both small tubular adenomas and serrated polyps. Gastrointest Endosc 2022 Feb 17. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.02.015)

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