Synchronous Large Nonpedunculated Lesions Are Most Common With a Left-Sided Nongranular Index Lesion
Douglas K. Rex, MD, MASGE, reviewing O’Sullivan T, et al. Clin Gastroenterol Hepatol 2023 Feb 12.
Large (≥20 mm) colorectal lesions are often accompanied by synchronous lesions, including a high prevalence of synchronous advanced lesions. This study examined the relationship between the features of the index (largest) lesion and the risk of a synchronous large (≥20 mm) nonpedunculated colorectal lesion (LNPCL).
In a multicenter prospective assessment of 3381 index lesions, 232 (6.9%) had a synchronous LNPCL. Nongranular LNPCLs (NG-LNPCLs) found in the left side of the colon had the highest risk for synchronous disease, with an odds ratio [OR] of 4.78 versus 1.99 for right-sided NG-LNPCLs. Size of an index lesion >35 mm also predicted a synchronous LNPCL (OR, 1.65).
Synchronous lesions tended to be in the same colonic location and have the same surface morphology.
COMMENTPatients with large colonic lesions, whether nonpedunculated or pedunculated, have a high prevalence of synchronous disease and require detailed clearing of the entire colon. Nongranular lesions are relatively easily missed. This paper emphasizes the importance of meticulous searching for additional nongranular lesions when a large nongranular lesion is detected.
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)
O’Sullivan T, Tate D, Sidhu M, et al. The surface morphology of large non pedunculated colonic polyps predicts synchronous large lesions. Clin Gastroenterol Hepatol 2023 Feb 12. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2023.01.034)
