EVALUATION OF THE RISK FOR METACHRONOUS COLORECTAL NEOPLASMS FOLLOWING INTESTINAL POLYPECTOMY - A CLINICAL, ENDOSCOPIC AND PATHOLOGICAL-STUDY

BACKGROUND/AIMS: Surveillance programs are recommended for patients wi th previous intestinal polypectomy because of the high rate of adenoma tous recurrences and risk of subsequent colorectal cancer. The paramet ers to identify patients at higher risk and the length and schedules o f follow-up have not yet been established. We considered some clinical , endoscopic and pathological parameters in order to assess the probab ility of developing new colorectal neoplasms and eventually to schedul e proper surveillance programs. METHODOLOGY: Patients with removed ade nomas were enrolled into a clinico-endoscopic follow-up, comprehensive of two colonoscopies the first at 1 year and the second at 3 years. W e evaluated the risk of new neoplasms dividing the patients into four groups according to the number and size of the adenomas removed and th e parameters considered. RESULTS: Of 164 patients enrolled 156 complet ed the study. We had an overall 21.3% of adenomatous recurrences at 1 year and 12.8% at 3 years. Most of the adenomas removed were tubular a nd small in size (<1 cm). The percentage of patients who had adenomas with advanced pathological features was 1.82% at 1 year and 0.64% at 3 years. The increase in number and size of the adenomas removed on the initial colonoscopic examination was the only one parameter statistic ally significant, X(2)1 (trend) 5.11; p<0.05 at the first follow-up an d X(2)1 (trend) 4.87; p<0.05 at the second follow-up. CONCLUSIONS: Pat ients with previous single adenoma showed few recurrences of extremely benign histological features. Since they do not require short-term en doscopic examination, it would be reasonable to defer the next colonos copy for at least another 5 years. During follow-up, patients with mul tiple polyps had adenomas with advanced pathological features so it Ra s useful to follow-up at 1 year. The tendency for advanced pathologica l features of removed polyps was not seen at 3 years, suggesting the i mportance of long-term follow-up, but with longer intervals.