Study On Population Screening With High Recurrence After Endoscopic Polypectomy Of Colorectal Adenomatous Polyps

BACKGROUND:Colorectal polyp is a kind of common digestive disease, which is a neoplasm originated from the colonic mucosa epidermis. The incidence of colorectal polyp is relatively high, some studies reported that the incidence of adenomas were up to30%-50%after65years. Colorectal polyps include neoplastic polyps and non-neoplastic polyps. Neoplastic polyps include tubular adenomas, villous adenoma and tubular-villous adenomas, and non-neoplastic polyps include inflammatory polyps, hyperplastic polyps and hamartoma polyps. Most patients with colorectal polyps are asymptomatic, only a few have manifestations such as abdominal pain, bloating, abdominal discomfort, diarrhea, blood in the stool, stool changes, polyps are often only found under electronic colonoscopy. Muto T,et al proposed "adenoma-carcinoma sequential theory" and this theory has been recognized. Colorectal polyps, especially adenomatous polyps are considered precancerous lesions, so adenomatous polyps should be promptly removed once found. Endoscopic polypectomy of colorectal adenomatous polyps is gradually replacing the traditional surgery because of some advantages, such as less trauma, safe, quick recovery, low cost, and easy to be received. Detection and removal of adenomas timely under endoscopy can significantly reduce the incidence of colorectal cancer. The National Polyp Study Workgroup found that the risk of colorectal cancer can be reduced76%-90%compared with the control group. However, the recurrence of adenomatous polyps can still reach up to20%-50%after3-5years, and new adenomas still have malignant potential and therefore regular follow-up and timely colonoscopic treatment are needed. Previous studies have found that factors associated with adenomatous polyp recurrence are complicated. There is no internationally recognized follow-up strategies today, and domestic large population studies on high recurrence of adenomatous polyps after endoscopic resection is less.OBJECTIVE:This study was designed to study various factors related to the recurrence of adenomatous polyps after endoscopic resection in order to filter out high-risk populations who had high recurrence rate and tended to suffer cancer. At the same time, this study could provide basis for follow-up observation and theoretical guidance for endoscopists in clinical work, both avoid unnecessary waste of medical resources and alleviate the suffering of patients undergoing colonoscopy.METHODS:This study analyzed relevant information of adenomatous polyp patients (a total of928cases) retrospectively from January2000to March2013in the Second Hospital of Shandong University. We divided these cases into different groups in accordance with the patient’s age, sex, number of adenomas, adenomatous diameter, adenomatous site, adenomatous type, adenomatous degree of neoplasia adenomatous bottom of the base and therapy approach and analyzed the number of recurrent cases. Then we applied SPSS18.0statistical software to perform univariate Χ2tests and multivariate Logistic regression analysis for statistical inference. We analyzed the relations of adenoma recurrence with patient’s age, gender, number of adenomas, adenomatous diameter, adenomatous site, adenomatous type, adenomatous degree of neoplasia, adenomatous bottom of the base and therapy approach. And then performed multivariate Logistic regression analysis in order to find independent risk factors associated with adenomatous recurrence.RESULT:1. A total of249Patients of the928cases who met the criteria recurred adenomas during the period of follow-up, the recurrence ratio was26.83%in all.2. Univariate Χ2test indicated that recurrence rate had statistical difference among patient’s age (P=0.045), number of adenomas (P=0.002), adenomatous diameter (P<0.001), adenomatous site (P=0.049), adenomatous type (P=0.001), adenomatous degree of neoplasia (P<0.001), basilar part (P<0.001), therapy approach (P=0.002), but had no significant difference (P=0.510) between gender.3Multivariate Logistic regression analysis showed that recurrence rate had statistical difference among patient’s age (P=0.011), adenomatous number (P=0.036), adenomatous diameter (P=0.029), adenomatous type (P=0.028), adenomatous degree of neoplasia (P=0.043), the bottom of adenomas(P=0.029) whereas had no significant difference among adenomatous site (P=0.301) and treatment approach (P=0.866).Conclusion:1. Adenomatous polyps still had a higher recurrence rate after endoscopic treatment and regular follow-up is needed.2.We found that adenomatous recurrence were associated with patient’s age, the number of adenomas, adenomatous diameter, adenomatous site, adenomatous type, adenomatous degree of neoplasia, the bottom of adenomas, therapy approach, but had no significant correlation with gender by univariate x2test3.Multivariate Logistic regression analysis indiciated that the patient’s age, the number of adenomas, adenomatous diameter, adenomatous type, adenomatous degree of neoplasia, the bottom of adenomas were independent risk factors for of adenomatous recurrence, but adenomatous site and treatment approach were not independent risk factors.4.1f a patient meets the age>60years, the number of adenomas>3, adenomatous diameter>10mm, villous histology, high-grade neoplasia and sessile, he is one of high-risk groups. The more risk factors that meet, the more likely adenomas recur and shorter follow-up period is required.