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Association of Morphology of Large Non-Pedunculated Colonic Polyps With Synchronous Large Lesions
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Among 3381 patients with large non-pedunculated colonic polyps (LNPCPs), synchronous lesions were found in 6.9% of the patients. Patients with left-sided LNPCPs that were non-granular were at the highest risk of having a synchronous lesion (OR, 4.78).
- Patients with non-granular or left-sided LNPCPs may benefit from more aggressive surveillance intervals, given their increased risk of having synchronous LNPCPs.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND AND AIMS
Large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) may have synchronous LNPCPs in up to 18% of cases. The nature of this relationship has not been investigated. We aimed to examine the relationship between individual LNPCP characteristics and synchronous colonic LNPCPs.
METHODS
Consecutive patients referred for resection of LNPCPs over 130 months until March 2022 were enrolled. Serrated lesions and mixed granularity LNPCPs were excluded from analysis. Patients with multiple LNPCPs resected were identified and the largest labelled as 'dominant'. The primary outcome was the identification of individual lesion characteristics associated with the presence of synchronous LNPCPs.
RESULTS
3149/3381 (93.1%) patients had a single LNPCP. In 232 (6.9%) a synchronous lesion was detected. Solitary lesions had a median size of 35mm with a predominant Paris 0-IIa morphology (42.9%) and right colon (59.5%) location. In patients with ≥2 LNPCPs, the dominant lesion had a median size of 40mm, Paris 0-IIa (47.6%) morphology and right colon (65.9%) location. In this group, 35.8% of dominant LNPCPs were non-granular compared to 18.7% in the solitary LNPCP cohort. Non-granular (NG)-LNPCPs were more likely to demonstrate synchronous disease with left colon NG-LNPCPs demonstrating greater risk (OR 4.78 95% CI 2.95-7.73) than right colon NG-LNPCPs (OR 1.99 95% CI 1.39-2.86).
CONCLUSION
6.9% of LNPCPs have synchronous disease with NG-LNPCPs demonstrating a greater than fourfold increased risk. With post-colonoscopy interval cancers exceeding 5%, endoscopists must be cognisant of an individual's LNPCP phenotype when examining the colon at both index procedure and surveillance.
Additional Info
Disclosure statements are available on the authors' profiles:
The surface morphology of large non pedunculated colonic polyps predicts synchronous large lesions
Clin. Gastroenterol. Hepatol. 2023 Feb 12;[EPub Ahead of Print], T O'Sullivan, D Tate, M Sidhu, S Gupta, J Elhindi, K Byth, O Cronin, A Whitfield, A Craciun, R Singh, G Brown, S Raftopoulos, L Hourigan, A Moss, A Klein, S Heitman, S Williams, E Lee, NG Burgess, MJ BourkeFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Many polyp-related features, including number of polyps, polyp size, and histology, are associated with the risk of metachronous advanced neoplasia. It is uncommon for most endoscopists to encounter patients with large (>20 mm) non-pedunculated colonic polyps (LNPCPs) outside of high-volume referral centers that specialize in complex endoscopic resection. Nonetheless, the implications for endoscopists and patients who harbor LNPCPs are important. It is reported that nearly 1 in 5 of these patients will have synchronous LNPCPs and that these polyps often go undetected at index or resection colonoscopy,1 which can impart a high risk of post-colonoscopy colorectal cancer (PCCRC).
O’Sullivan et al aimed to identify the relationship between specific characteristics of LNPCPs and synchronous LNPCPs. They utilized a prospectively maintained Australian multicenter cohort of patients referred to expert centers for resection of LNPCPs. Polyp size, morphology using Paris classification, location, and granularity were analyzed using multivariable logistic regression to assess the odds of synchronous disease. Overall, 7% of the 3381 patients with an LNPCP had a synchronous LNPCP. Polyp granularity, size, and location, but not polyp nodularity (Paris classification), were associated with the presence of synchronous LNPCPs. In this cohort, synchronous LNPCPs are associated with specific high-risk features including a non-granular appearance, size >35 mm, and location distal to the mid-transverse colon. Unfortunately, true rates of synchronous lesions were not established by this study as information about the number of polyps and features of lesions removed on colonoscopy prior to referral to the expert resection centers were not ascertained.
Meticulous mucosal inspection, high rates of polyp detection, and complete polyp resection are imperative for all endoscopists performing colonoscopy. The stakes for missing one or more synchronous high-risk lesions in patients with LNPCPs could be lethal and warrant heightened awareness of factors associated with their presence.
Reference
1. Bick BL, Ponugoti PL, Rex DK. High yield of synchronous lesions in referred patients with large lateral spreading colorectal tumors. Gastrointest Endosc. 2017;85(1):228-233. https://www.giejournal.org/article/S0016-5107(16)30281-4/fulltext