Abstract
The Effects of Polyp Size Inaccuracy on Clinical Management of Colorectal Adenomas: 130
The American journal of gastroenterology, Vol.111, p.S62
10/2016
DOI: 10.14309/00000434-201610001-00130
Abstract
Introduction: Endoscopists' estimate of polyp size is often inaccurate. Adenoma surveillance intervals and the very definition of advanced adenomas depend on polyp size. Most publications relating risk of metachronous neoplasia to polyp size use endoscopic measurements, not pathology, or do not state what measurement was used. The authors have previously shown a systematic overestimate of 31% in the endoscopic estimation of adenoma size compared to pathology. We wanted to examine the effect of such an overestimate on surveillance intervals after polypectomy.
Methods: We queried a single endoscopist prospectively maintained polyp database which recorded every polyp removed during colonoscopy from 1995 to 2013. We identified 6939 adenomas. We abstracted the endoscopic estimate of the largest diameter of each adenoma and calculated pathologic size by applying the regression equation derived from the prior study: endoscopic size = 0.7 + 1.175 x pathologic size (r2=0.766). Adenomas ≥10mm are “advanced”. We calculated the incidence of advanced adenomas using size criteria, and then all three criteria (including villosity and high grade dysplasia).
Results: The table shows the breakdown of adenomas by endoscopic and derived pathologic size, and reflects the 31% overestimate inherent in the colonoscopist's technique. If all criteria for advanced adenomas were included the incidence was 1517 (21.9%) by endoscopy and 1196 (17.2%) by pathology. By size alone, 1295 were endoscopically advanced compared to 893 by pathology.
Conclusion: The size of adenomas is an important indicator of their status as advanced lesions. Studies reporting endoscopic size underestimate the severity of the neoplasia by diluting the population of adenomas with small lesions. Recommended surveillance colonoscopy intervals after polypectomy are 3 years for advanced adenomas and 5 for non-advanced. Accurate assessment of polyp size is important in ensuring that resources are not wasted while high risk colons are not ignored. Future studies of the significance of colorectal adenomas should note how polyp size was measured.
Details
- Title: Subtitle
- The Effects of Polyp Size Inaccuracy on Clinical Management of Colorectal Adenomas: 130
- Creators
- Maysoon M. Gamaleldin - Cleveland ClinicJames Church - Cleveland Clinic
- Resource Type
- Abstract
- Publication Details
- The American journal of gastroenterology, Vol.111, p.S62
- DOI
- 10.14309/00000434-201610001-00130
- ISSN
- 0002-9270
- eISSN
- 1572-0241
- Publisher
- NATURE PUBLISHING GROUP
- Language
- English
- Date published
- 10/2016
- Academic Unit
- Surgery
- Record Identifier
- 9984966837302771
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