Endoscopy 2022; 54(S 01): S42
DOI: 10.1055/s-0042-1744645
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RISK FACTORS FOR METACHRONOUS COLORECTAL CANCER OR ADVANCED ADENOMAS AFTER ENDOSCOPIC RESECTION OF HIGH RISK ADENOMAS: A SYSTEMATIC REVIEW AND META-ANALYSIS

S. Baile-Maxía
1   Gastroenterology Department. Hospital Universitario del Vinalopó, Alicante, Spain
,
C. Mangas-Sanjuan
2   Gastroenterology Department. Hospital General Universitario de Alicante, Alicante, Spain
,
U. Ladabaum
3   Division of Gastroenterology and Hepatology. Stanford University School of Medicine, Stanford CA, United States
,
C. Hassan
4   Gastroenterology Department. Nuovo Regina Margarita Hospital., Rome, Italy
,
M.D Rutter
5   Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
,
M. Bretthauer
6   Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
L. Medina-Prado
2   Gastroenterology Department. Hospital General Universitario de Alicante, Alicante, Spain
,
O. Murcia
2   Gastroenterology Department. Hospital General Universitario de Alicante, Alicante, Spain
,
P. Zapater
7   Clinical Pharmacology Department. Hospital General Universitario de Alicante. Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
,
R. Jover
8   Gastroenterology Department. Hospital General Universitario de Alicante., Alicante, Spain
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Aims To assess which high-risk adenoma (HRA) characteristics are associated with high risk of metachronous colorectal cancer (CRC) or advanced adenomas (AA).

Methods We systematically searched Pubmed, EMBASE and Cochrane for cohort, case-control and clinical trials of CRC or AA incidence at surveillance stratified by baseline lesion size, histology and multiplicity. We calculated pooled relative risks (RR) using a random-effects model. Heterogeneity was assessed with the I2 statistic.

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Fig. 1

Results Sixty-eight studies were included, with 731,040 patients. CRC incidence per 1,000 person-years was 2.6 (2.1–3.0) for adenomas≥20mm, 2.8 (2.3–3-3) for high-grade dysplasia (HGD), 2.1 (1.8–2.3) for villous component, 1.2 (0.3– 1.9) for≥5 adenomas, and 1.4 (0.8–2.3) for≥3 adenomas. Metachronous CRC risk was higher in patients with adenomas≥20mm vs. adenomas 10-20 mm (RR 2.08, 95%CI 1.20-3.61), HGD vs low-grade dysplasia (RR 2.94, 95%CI 1.97-4.39) and villous component vs. tubular adenomas (RR 1.75, 95%CI 1.35-2.24). No differences in metachronous CRC risk were found in patients with≥5 adenomas vs those with 3-4 (RR 1.07, 95% CI 0.44-2.57), nor in patients with≥3 adenomas vs 1-2 (RR 1.60, 95% CI 0.94-2.74). Similar trends were seen for metachronous AA. The absolute risk differences for CRC incidence were low, ranging from 0.05% increase in absolute risk in patients with>5 adenomas to 0.14% in patients with HGD.

Conclusions Metachronous CRC risk is highest in patients with baseline adenomas with size>20mm, HGD, or villous component. Multiplicity does not seem to be associated with a substantially higher CRC risk.



Publication History

Article published online:
14 April 2022

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