New predictors of recurrence in post-polypectomy surveillance - A retrospective analysis of risk stratification for advanced adenomas and polyps.

Abstract

Background and aims: recent guidelines emphasized that not all patients with recurrent polyps benefit from post-polypectomy surveillance, except for advanced adenomas recurrence. This study aimed to analyze the recurrence risk factors for advanced adenomas and investigated the difference from any polyp recurrence.

Methods: this retrospective observational study included patients who underwent colonoscopy and at least one post-polypectomy surveillance. Multivariate regression models identified risk factors for the recurrence of polyps and advanced adenomas. The Youden index determined the optimal cut-off value for risk factors. Kaplan-Meier curve estimated the cumulative recurrence rates, and the log-rank tests compared the differences between these curves.

Results: a total of 1,818 patients had polyps at baseline examination. During post-polypectomy surveillance, 1,063 patients had recurrent polyps, and 64 patients experienced recurrent advanced adenomas. Multivariate logistic analysis identified age as an independent risk factor for both advanced adenoma (OR [95 % CI]: 1.028 [1.003-1.056]) and polyps (OR [95 % CI]: 1.019 [1.009-1.028]), with cut-off values of 57 years and 53 years, respectively. A cut-off value of 40 years can increase the predictive sensitivity to 95 %. Polyps size (OR [95 % CI]: 1.070 [1.014-1.147]) and high-risk pathology (OR [95 % CI]: 6.339 [2.057-23.919]) were significantly associated with recurrence of advanced adenomas, but not with any polyps, with a size cut-off value of 7.5 mm. Except for high-risk pathology, neither hyperplastic polyps nor tubular adenomas with low-grade dysplasia increased the recurrence risk of advanced adenomas.

Conclusions: a cut-off value of 40 years can increase the predictive sensitivity to 95 % for both advanced adenomas and any polyps. Polyps size and high-risk pathology were associated with the recurrence of advanced adenoma, but not with any polyps.