Colon to Rectum
Clin Gastroenterol Hepatol. 2023;21(9):2270–7.e1
The surface morphology of large non-pedunculated colonic polyps predicts synchronous large lesions
Background and aims: Large (≥ 20 mm) non-pedunculated colorectal polyps (LNPCPs) may have synchronous LNPCPs in up to 18% of cases. The nature of this relationship has not been investigated. The authors 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 morphology (47.6%), 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 [OR] = 4.78; 95% confidence interval [CI]: 2.95–7.73) than right colon NG-LNPCPs (OR = 1.99; 95% CI: 1.39–2.86).
Conclusions: It was found that 6.9% of large non-pedunculated colorectal polyps (LNPCPs) have synchronous disease, with non-granular LNPCPs demonstrating a greater than 4-fold increased risk. With post-colonoscopy interval cancers exceeding 5%, endoscopists must be cognizant of an individual’s LNP CP phenotype when examining the colon at both index procedure and surveillance.