Incidence and predictors of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas

Gastrointest Endosc. 2009 Aug;70(2):344-9. doi: 10.1016/j.gie.2008.10.037. Epub 2009 Feb 27.


Background: Large sessile colorectal adenomas (>/=2 cm in size) resected piecemeal have a 0% to 55% rate of residual adenoma at the first follow-up. Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent "late" recurrence.

Objective: Our aim was to describe long-term follow-up of large sessile adenomas after piecemeal resection and to report the incidence and predictors of "late" recurrence.

Design: A retrospective study.

Setting: A tertiary-referral center.

Patients and interventions: Large sessile colorectal adenomas were identified through an endoscopic database. Polyps were resected by piecemeal technique; flat areas that could not be snared were treated with argon plasma coagulation. Patients who completed follow-up examinations at our center 3 to 6 months and at least 1 year after initial resection were included.

Main outcome measurements: "Late" adenoma recurrence.

Results: Of 136 polyps with complete follow-up, 24 (17.6%) had macroscopically evident residual adenoma at follow-up, including 18 at the first follow-up and 6 (4.4%) with a "late" recurrence. Among 94 polyps with no visible adenoma and with negative biopsy specimens of the scar at the first follow-up, 92 polyps (97.9%) were eradicated at late follow-up, compared with 36 of 42 (85.7%) of the remaining polyps (P = .005).

Limitation: A retrospective design.

Conclusion: Our results confirm the phenomenon of "late" recurrences after endoscopic piecemeal resection of large sessile adenomas. However, a normal macroscopic appearance of the polypectomy site and negative scar biopsy specimens at the first follow-up is predictive of long-term eradication.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenomatous Polyps / epidemiology*
  • Adenomatous Polyps / pathology
  • Adenomatous Polyps / surgery*
  • Adult
  • Aged
  • Aged, 80 and over
  • Colonoscopy*
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology*
  • Retrospective Studies
  • Time Factors