Original article
Clinical endoscopy
High yield of synchronous lesions in referred patients with large lateral spreading colorectal tumors

https://doi.org/10.1016/j.gie.2016.06.035Get rights and content

Background and Aims

There are few data on the prevalence of synchronous colorectal lesions in patients who have large lateral spreading tumors (LLSTs). We sought to describe the rate of synchronous lesions found in patients who underwent endoscopic resection of large sessile adenomas and serrated lesions.

Methods

This is a retrospective assessment of a prospectively created database of 728 consecutive patients with resected LLSTs who underwent complete clearing of the colon during 2 colonoscopies by a single expert endoscopist.

Results

The 728 patients with resected LLSTs and complete clearing had 4578 synchronous lesions, including 584 patients (80.2%) with at least 1 synchronous conventional adenoma, 132 (18.1%) with at least 1 synchronous conventional adenoma ≥ 20 mm in size, 294 (40.4%) with at least 1 synchronous advanced conventional adenoma, and 6 patients with a synchronous lesion with cancer. Patients with an index large sessile conventional adenoma compared with those with an index large serrated lesion had on average more synchronous conventional adenomas (4.8 vs 2.9, P = .001) and fewer synchronous serrated lesions (1.4 vs 4.5, P < .001). Of the 97 patients with a serrated class index lesion, 28 (28.9%) met criteria for serrated polyposis.

Conclusions

There is a very high prevalence of synchronous lesions, including other large and advanced synchronous lesions, in patients with flat or sessile conventional adenomas and serrated colorectal polyps. Patients with LLSTs in the colon need detailed clearing of the rest of the colon. Patients referred for endoscopic resection of serrated lesions ≥ 20 mm have a very high prevalence of serrated polyposis. This study has potential implications for further stratification of high-risk patient groups in postpolypectomy surveillance guidelines.

Section snippets

Methods

This is a retrospective evaluation of a prospectively created database of LLSTs (≥20 mm in size) referred to and resected by a single endoscopist (D.K.R.) between April 2000 and December 2015. Review of the database was approved by the Institutional Review Board at Indiana University Health Partners on June 16, 2015.

In many cases the LLST was removed during the baseline colonoscopy but the entire colon was not cleared until the first follow-up colonoscopy. Patients were encouraged to return to

Results

There were 1029 consecutive patients with sessile or flat lesions ≥ 20 mm in diameter identified in the database; 296 patients were excluded because they only had 1 colonoscopy performed by our endoscopist (D.K.R.). Patients had only 1 colonoscopy if they did not return to our center for follow-up (n = 239), if they were referred for surgical resection because the index lesion had endoscopic features of cancer (biopsy samples were taken from the lesions and patients referred to surgery, n =

Discussion

In this report we describe the prevalence of synchronous lesions in 728 primarily referred patients with large flat or sessile colorectal lateral spreading tumors who underwent colonoscopic clearance over 2 colonoscopies by a single expert endoscopist. The prevalence of synchronous conventional adenomas and synchronous serrated class lesions was very high. Our study indicates that patients with large sessile or flat lateral spreading tumors ≥ 20 mm in size demand detailed clearance of the colon

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  • Cited by (0)

    DISCLOSURE: The following author received research support for this study from a gift from Scott and Kay Schurz and their family of Bloomington, Indiana to the Indiana University Foundation: D. K. Rex. In addition, the following author disclosed financial relationships relevant to this publication: D. K. Rex: Consultant for Olympus. All other authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact Dr Rex at [email protected].

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