Incidence and predictors of late recurrences after endoscopic piecemeal resection of large sessile adenomas

Background: Large sessile colorectal adenomas (>= 2 cm in size) resected piecemeal have a 0% to 55% rate of residual adenoma at the first follow-up. Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent late recurrence. Objective: Our aim was to describe long-term follow-up of large sessile adenomas after piecemeal resection and to report the incidence and predictors of late recurrence. Design: A retrospective study Setting: A tertiary-referral center. Patients and Interventions: Large sessile colorectal adenomas were identified through an endoscopic database. Polyps were resected by piecemeal technique; flat areas that Could not be snared were treated with argon plasma coagulation. Patients who completed follow-up examinations at our center 3 to 6 months and at least I year after initial resection were included. Main Outcome Measurements: Late adenoma recurrence. Results: Of 136 polyps with complete follow-up, 24 (17.6%) had macroscopically evident residual adenoma at follow-up, including 18 at the first follow-up and 6 (4.4%) with a late recurrence. Among 94 polyps with no visible adenoma and with negative biopsy specimens of the scar at the first follow-up, 92 polyps (97.9%) were eradicated at late follow-up, compared with 36 of 42 (85.7%) of the remaining polyps (P=.005). Limitation: A retrospective design. Conclusion: Our results confirm the phenomenon of late recurrences after endoscopic piecemeal resection of large sessile adenomas. However, a normal macroscopic appearance of the polypectomy site and negative scar biopsy specimens at the first follow-up is predictive of long-term eradication. (Gastrointest Endosc 2009;70:344-9.)