Risk of total metachronous advanced neoplasia at surveillance colonoscopy after detection of serrated lesions: a matched case-cohort study.

Autor:	Djinbachian R; Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada., Lafontaine ML; University of Montreal, Faculty of Medicine and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada., Anderson JC; Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States.; Division of Gastroenterology, VA Medical Center, White River Junction, Vermont, United States., Pohl H; Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States.; Division of Gastroenterology, VA Medical Center, White River Junction, Vermont, United States., Dufault T; University of Montreal, Faculty of Medicine and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada., Boivin M; Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada., Bouin M; Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada., von Renteln D; Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada.
Jazyk:	angličtina
Zdroj:	Endoscopy [Endoscopy] 2023 Aug; Vol. 55 (8), pp. 728-736. Date of Electronic Publication: 2023 Jan 26.
DOI:	10.1055/a-2020-6797
Abstrakt:	BACKGROUND : Serrated lesions are potential colorectal cancer precursors. This study evaluated the presence of total metachronous advanced neoplasia (T-MAN) at follow-up in patients with index serrated lesions compared with a matched cohort without serrated lesions. METHODS : Patients aged 45-74 years with serrated lesions were matched 2:1 by sex, age, synchronous polyps, and timing of index colonoscopy, to patients without serrated lesions. The primary outcome was T-MAN (advanced adenoma or high-risk serrated lesion) at follow-up. Secondary outcomes included presence of T-MAN stratified by synchronous polyps and serrated lesion characteristics. RESULTS : 1425 patients were included (475 patients, 642 serrated lesions; 950 controls; median follow-up 2.9 versus 3.6 years). Patients with serrated lesions had greater risk of T-MAN than those without (hazard ratio [HR] 6.1, 95 %CI 3.9-9.6). Patients with serrated lesions and high-risk adenoma (HRA) had higher risk of T-MAN than those with HRA alone (HR 2.6, 95 %CI 1.4-4.7); similarly, patients with serrated lesions plus low-risk adenoma (LRA) had higher risk than those with LRA alone (HR 7.0, 95 %CI 2.8-18.4), as did patients with serrated lesions without adenoma compared with no adenoma (HR 14.9, 95 %CI 6.5-34.0). Presence of proximal sessile serrated lesion (SSL; HR 9.3, 95 %CI 5.4-15.9), large SSL (HR 17.8, 95 %CI 7.4-43.3), and proximal large SSL (HR 25.0, 95 %CI 8.8-71.3), but not distal SSL, were associated with greater risk for T-MAN. CONCLUSION : Patients with serrated lesions had higher risk for T-MAN regardless of synchronous adenomas. Patients with serrated lesions and HRA, and those with large or proximal SSLs, were at greatest risk. Competing Interests: R. Djinbachian was supported by a resident clinical research award from the American College of Gastroenterology for the conduction of this study. The study was performed independently from the funder. Daniel von Renteln is supported by a “Fonds de Recherche du Québec Santé” (FRQS) career development award and has received research funding from ERBE, Ventage, Pendopharm, and Pentax and is a consultant for Boston Scientific and Pendopharm. M.L. Lafontaine, J. Anderson, H. Pohl, T. Dufault, M. Boivin, and M. Bouin declare that they have no conflict of interest. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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