Endoscopic and histopathologic predictors of recurrence of colorectal adenoma on lowering the miss rate

Abstract

Background/aims: Although colorectal adenoma is reported to recur frequently, this may result from missing it at baseline. However, few studies of recurrence have considered the miss rate. This study evaluated the recurrence rate prospectively and clinical predictors of recurrence in colorectal adenoma after lowering the miss rate.

Methods: The study population comprised 128 patients who underwent baseline colonoscopy with resection of colorectal adenomas. Re-examination to lower the miss rate was performed within 2 months. Follow-up colonoscopy to detect recurrence was done more than 1 year after removal.

Results: The mean follow-up period was 35.1 months (range, 12 to 84 months). Thirty patients had a recurrent adenoma, for a recurrence rate of 23.4%. Older patients (over 60 years) had a two-fold greater risk of recurrence than younger patients (hazard ratio, 2.39; 95% confidence interval [CI], 1.16-4.90). Patients with three or four adenomas at baseline colonoscopy had a two-fold greater risk than those with one adenoma (hazard ratio, 2.44; 95% CI, 1.11-5.35). Patients with advanced adenoma had a two-fold greater risk than those with no advanced adenoma (hazard ratio, 2.88; 95% CI, 1.40-5.95). In multivariate analysis, only the presence of three or four adenomas independently predicted the recurrence of adenoma (hazard ratio, 3.19; 95% CI, 1.04-9.79).

Conclusions: The recurrence rate of colorectal adenoma corrected by lowering the miss rate was lower than reported rates. The presence of multiple adenomas on initial colonoscopy was an important predictor of recurrence.

Keywords: Colorectal adenoma; Miss rate; Recurrence rate.

Figure 1

Annual recurrence rate of adenoma. The recurrence rate was 27.5, 14.3, 12.5, 4.2, 0, and 20% in year 1-2, 2-3, 3-4, 4-5, 5-6, and 6-7 of the follow-up period, respectively.

Figure 2

The cumulative adenoma recurrence rate according to the number of adenomas and presence of advanced adenoma. (A) Patients with three or four adenomas at baseline colonoscopy had a greater recurrence rate than those with one adenoma. (B) Patients with an advanced adenoma had greater recurrence than those without.