Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas

Background

Large sessile colorectal adenomas (≥2 cm in size) resected piecemeal have a 0% to 55% rate of residual adenoma at the first follow-up. Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent “late” recurrence.

Objective

Our aim was to describe long-term follow-up of large sessile adenomas after piecemeal resection and to report the incidence and predictors of “late” recurrence.

Design

A retrospective study.

Setting

A tertiary-referral center.

Patients and Interventions

Large sessile colorectal adenomas were identified through an endoscopic database. Polyps were resected by piecemeal technique; flat areas that could not be snared were treated with argon plasma coagulation. Patients who completed follow-up examinations at our center 3 to 6 months and at least 1 year after initial resection were included.

Main Outcome Measurements

“Late” adenoma recurrence.

Results

Of 136 polyps with complete follow-up, 24 (17.6%) had macroscopically evident residual adenoma at follow-up, including 18 at the first follow-up and 6 (4.4%) with a “late” recurrence. Among 94 polyps with no visible adenoma and with negative biopsy specimens of the scar at the first follow-up, 92 polyps (97.9%) were eradicated at late follow-up, compared with 36 of 42 (85.7%) of the remaining polyps (P = .005).

Limitation

A retrospective design.

Conclusion

Our results confirm the phenomenon of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. However, a normal macroscopic appearance of the polypectomy site and negative scar biopsy specimens at the first follow-up is predictive of long-term eradication.

Abbreviations: APC, argon plasma coagulation, ESD, endoscopic submucosal dissection, HGD, high-grade dysplasia