The Surface Morphology of Large Nonpedunculated Colonic Polyps Predicts Synchronous Large Lesions

Timothy O'Sullivan; David Tate; Mayenaaz Sidhu; Sunil Gupta; James Elhindi; Karen Byth; Oliver Cronin; Anthony Whitfield; Ana Craciun; Rajvinder Singh; Gregor Brown; Spiro Raftopoulos; Luke Hourigan; Alan Moss; Amir Klein; Steven Heitman; Stephen Williams; Eric Lee; Nicholas G Burgess; Michael J Bourke

doi:10.1016/j.cgh.2023.01.034

The Surface Morphology of Large Nonpedunculated Colonic Polyps Predicts Synchronous Large Lesions

Clin Gastroenterol Hepatol. 2023 Aug;21(9):2270-2277.e1. doi: 10.1016/j.cgh.2023.01.034. Epub 2023 Feb 12.

Authors

Timothy O'Sullivan¹, David Tate², Mayenaaz Sidhu¹, Sunil Gupta¹, James Elhindi³, Karen Byth⁴, Oliver Cronin¹, Anthony Whitfield¹, Ana Craciun⁵, Rajvinder Singh⁶, Gregor Brown⁷, Spiro Raftopoulos⁸, Luke Hourigan⁹, Alan Moss¹⁰, Amir Klein¹¹, Steven Heitman¹², Stephen Williams¹³, Eric Lee¹³, Nicholas G Burgess¹, Michael J Bourke¹⁴

Affiliations

¹ Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.
² Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium; University of Ghent, Ghent, Belgium.
³ WSLHD Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia; WSLHD Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia.
⁵ Departamento de Gastrenterologia e Hepatologia, Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal.
⁶ Department of Gastroenterology and Hepatology, Lyell McEwan Hospital, Adelaide, South Australia, Australia.
⁷ Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Gastroenterology and Hepatology, Epworth Hospital, Melbourne, VIC, Australia.
⁸ Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia.
⁹ Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Department of Gastroenterology, Greenslopes Private Hospital, Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia.
¹⁰ Department of Endoscopic Services, Western Health, Melbourne, Victoria, Australia.
¹¹ Ambam Heath Care Campus, Technion Institute of Technology, Haifa, Israel; Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
¹² Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹³ Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.
¹⁴ Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia. Electronic address: michael@citywestgastro.com.au.

PMID: 36787836
DOI: 10.1016/j.cgh.2023.01.034

Abstract

Background & aims: Large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) may have synchronous LNPCPs in up to 18% of cases. The nature of this relationship has not been investigated. We aimed to examine the relationship between individual LNPCP characteristics and synchronous colonic LNPCPs.

Methods: Consecutive patients referred for resection of LNPCPs over 130 months until March 2022 were enrolled. Serrated lesions and mixed granularity LNPCPs were excluded from analysis. Patients with multiple LNPCPs resected were identified, and the largest was labelled as dominant. The primary outcome was the identification of individual lesion characteristics associated with the presence of synchronous LNPCPs.

Results: There were 3149 of 3381 patients (93.1%) who had a single LNPCP. In 232 (6.9%) a synchronous lesion was detected. Solitary lesions had a median size of 35 mm with a predominant Paris 0-IIa morphology (42.9%) and right colon location (59.5%). In patients with ≥2 LNPCPs, the dominant lesion had a median size of 40 mm, Paris 0-IIa (47.6%) morphology, and right colon location (65.9%). In this group, 35.8% of dominant LNPCPs were non-granular compared with 18.7% in the solitary LNPCP cohort. Non-granular (NG)-LNPCPs were more likely to demonstrate synchronous disease, with left colon NG-LNPCPs demonstrating greater risk (odds ratio, 4.78; 95% confidence interval, 2.95-7.73) than right colon NG-LNPCPs (odds ratio, 1.99; 95% confidence interval, 1.39-2.86).

Conclusions: We found that 6.9% of LNPCPs have synchronous disease, with NG-LNPCPs demonstrating a greater than 4-fold increased risk. With post-colonoscopy interval cancers exceeding 5%, endoscopists must be cognizant of an individual's LNPCP phenotype when examining the colon at both index procedure and surveillance.

Clinicaltrials: gov, NCT01368289; NCT02000141; NCT02198729.

Keywords: Adenoma; Colonoscopy; Neoplasia; Polypectomy.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adenoma* / pathology
Colon / pathology
Colonic Polyps* / pathology
Colonoscopy
Colorectal Neoplasms* / epidemiology
Humans

Associated data

ClinicalTrials.gov/NCT02198729
ClinicalTrials.gov/NCT01368289
ClinicalTrials.gov/NCT02000141