Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience
<i>Background:</i> The aim of this study was to identify risk factors contributing to the malignancy of colorectal polyps, as well as risk factors for recurrence after the successful endoscopic mucosal resection of large colorectal polyps in a referral center. <i>Materials and Meth...
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MDPI AG
2022-10-01
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| Online Access: | https://www.mdpi.com/1648-9144/58/10/1440 |
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| author | Olga Mandic Igor Jovanovic Mirjana Cvetkovic Jasmina Maksimovic Tijana Radonjic Maja Popovic Novica Nikolic Marija Brankovic |
| author_facet | Olga Mandic Igor Jovanovic Mirjana Cvetkovic Jasmina Maksimovic Tijana Radonjic Maja Popovic Novica Nikolic Marija Brankovic |
| author_sort | Olga Mandic |
| collection | DOAJ |
| description | <i>Background:</i> The aim of this study was to identify risk factors contributing to the malignancy of colorectal polyps, as well as risk factors for recurrence after the successful endoscopic mucosal resection of large colorectal polyps in a referral center. <i>Materials and Methods</i>: This retrospective cohort study was performed in patients diagnosed with large (≥20 mm diameter) colorectal polyps and treated in the period from January 2014 to December 2019 at the University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia. Based on the endoscopic evaluation and classification of polyps, the following procedures were performed: en bloc resection, piecemeal resection or surgical treatment. <i>Results</i>: A total of 472 patients with large colorectal polyps were included in the study. The majority of the study population were male (62.9%), with a mean age of 65.7 ± 10.8 years. The majority of patients had one polyp (73.7%) less than 40 mm in size (74.6%) sessile morphology (46.4%), type IIA polyps (88.2%) or polyps localized in the descending colon (52.5%). The accessibility of the polyp was complicated in 17.4% of patients. En bloc resection was successfully performed in 61.0% of the patients, while the rate of piecemeal resection was 26.1%. Due to incomplete endoscopic resection, surgery was performed in 5.1% of the patients, while 7.8% of the patients were referred to surgery directly. Hematochezia (<i>p</i> = 0.001), type IIB polyps (<i>p</i> < 0.001) and complicated polyp accessibility (<i>p</i> = 0.002) were significant independent predictors of carcinoma presence in a multivariate logistic regression analysis. Out of the 472 patients enrolled in the study, 364 were followed after endoscopic resection for colorectal polyp recurrence, which was observed in 30 patients (8.2%) during follow-up. Piecemeal resection (<i>p</i> = 0.048) and incomplete resection success (<i>p</i> = 0.013) were significant independent predictors of polyp recurrence in the multivariate logistic regression analysis. <i>Conclusions:</i> Whenever an endoscopist encounters a complex colorectal lesion (i.e., a polyp with complicated accessibility), polyp size > 40 mm, the Laterally Spreading Tumor nongranular (LST-NG) morphological type, type IIB polyps or the presence of hematochezia, malignancy risk should be considered before making the decision to either resect, refer to an advanced endoscopist or perform surgery. |
| first_indexed | 2024-03-09T19:50:53Z |
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| language | English |
| last_indexed | 2024-03-09T19:50:53Z |
| publishDate | 2022-10-01 |
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| spelling | doaj.art-1555b91ba4b34d3b8aa38e162631605a2023-11-24T01:11:11ZengMDPI AGMedicina1010-660X1648-91442022-10-015810144010.3390/medicina58101440Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center ExperienceOlga Mandic0Igor Jovanovic1Mirjana Cvetkovic2Jasmina Maksimovic3Tijana Radonjic4Maja Popovic5Novica Nikolic6Marija Brankovic7Department of Gastroenterology and Hepatology, University Hospital Medical Center Bezanijska Kosa, 11000 Belgrade, SerbiaDepartment of Gastroenterology and Hepatology, University Hospital Medical Center Bezanijska Kosa, 11000 Belgrade, SerbiaDepartment of Gastroenterology and Hepatology, University Hospital Medical Center Bezanijska Kosa, 11000 Belgrade, SerbiaDepartment of Gastroenterology and Hepatology, University Hospital Medical Center Bezanijska Kosa, 11000 Belgrade, SerbiaDepartment of Gastroenterology and Hepatology, University Hospital Medical Center Bezanijska Kosa, 11000 Belgrade, SerbiaDepartment of Radiology, University Hospital Medical Center Bezanijska Kosa, 11000 Belgrade, SerbiaDepartment of Anesthesiology and Reanimation, University Hospital Medical Center Bezanijska Kosa, 11000 Belgrade, SerbiaDepartment of Gastroenterology and Hepatology, University Hospital Medical Center Bezanijska Kosa, 11000 Belgrade, Serbia<i>Background:</i> The aim of this study was to identify risk factors contributing to the malignancy of colorectal polyps, as well as risk factors for recurrence after the successful endoscopic mucosal resection of large colorectal polyps in a referral center. <i>Materials and Methods</i>: This retrospective cohort study was performed in patients diagnosed with large (≥20 mm diameter) colorectal polyps and treated in the period from January 2014 to December 2019 at the University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia. Based on the endoscopic evaluation and classification of polyps, the following procedures were performed: en bloc resection, piecemeal resection or surgical treatment. <i>Results</i>: A total of 472 patients with large colorectal polyps were included in the study. The majority of the study population were male (62.9%), with a mean age of 65.7 ± 10.8 years. The majority of patients had one polyp (73.7%) less than 40 mm in size (74.6%) sessile morphology (46.4%), type IIA polyps (88.2%) or polyps localized in the descending colon (52.5%). The accessibility of the polyp was complicated in 17.4% of patients. En bloc resection was successfully performed in 61.0% of the patients, while the rate of piecemeal resection was 26.1%. Due to incomplete endoscopic resection, surgery was performed in 5.1% of the patients, while 7.8% of the patients were referred to surgery directly. Hematochezia (<i>p</i> = 0.001), type IIB polyps (<i>p</i> < 0.001) and complicated polyp accessibility (<i>p</i> = 0.002) were significant independent predictors of carcinoma presence in a multivariate logistic regression analysis. Out of the 472 patients enrolled in the study, 364 were followed after endoscopic resection for colorectal polyp recurrence, which was observed in 30 patients (8.2%) during follow-up. Piecemeal resection (<i>p</i> = 0.048) and incomplete resection success (<i>p</i> = 0.013) were significant independent predictors of polyp recurrence in the multivariate logistic regression analysis. <i>Conclusions:</i> Whenever an endoscopist encounters a complex colorectal lesion (i.e., a polyp with complicated accessibility), polyp size > 40 mm, the Laterally Spreading Tumor nongranular (LST-NG) morphological type, type IIB polyps or the presence of hematochezia, malignancy risk should be considered before making the decision to either resect, refer to an advanced endoscopist or perform surgery.https://www.mdpi.com/1648-9144/58/10/1440colorectal polypendoscopic mucosal resectionmalignancyrecurrence |
| spellingShingle | Olga Mandic Igor Jovanovic Mirjana Cvetkovic Jasmina Maksimovic Tijana Radonjic Maja Popovic Novica Nikolic Marija Brankovic Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience Medicina colorectal polyp endoscopic mucosal resection malignancy recurrence |
| title | Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience |
| title_full | Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience |
| title_fullStr | Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience |
| title_full_unstemmed | Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience |
| title_short | Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience |
| title_sort | factors predicting malignant occurrence and polyp recurrence after the endoscopic resection of large colorectal polyps a single center experience |
| topic | colorectal polyp endoscopic mucosal resection malignancy recurrence |
| url | https://www.mdpi.com/1648-9144/58/10/1440 |
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