Analysis Of Recurrence Factors After Endoscopic Polypectomy Of Colorectal Adenomatous Polyps

Background:Colorectal cancer is one of the common digestive malignant tumor.With the improvement of living standards of residents in China,the morbidity and mortality of colorectal cancer are increasing year by year.Colorectal adenomas are the main precancerous lesions of colorectal cancer.And the incidence of colorectal cancer can be controlled to some degree through early detection and treatment of colorectal adenomas.Colonoscopy is recognized to be one of the most effective method to screen colorectal cancer,which can facilitate to both find and resect the adenomas at the same time.Due to the high recurrence rate of colorectal adenomas after endoscopic resection,it is necessary for close colonoscopy monitoring of colorectal adenomas.At present,there is still not a unified follow-up strategy for colorectal adenomas resection in China.Because of some problems in colonoscopy like missed diagnosis,most adenoma patients are required to closely follow up by domestic doctors in a relatively short time.Frequent colonoscopy either cause waste of medical resources or make the patient repeatedly suffer the pain of colonoscopy examination,so a confirmed follow-up period of patients with colorectal adenomas after complete resection really needs to be further researched in our country.Object:This aim of this research was to find out associated recurrence factors of adenoma by analysis of the recurrence conditions of patients with colorectal adenomas via endoscopic resection in Jilin area.Then to screen the high-risk populations with recurrent possibility in order to provide reference for follow-up observation of this kind patients in clinical work.Methods:A retrospective analysis was made about the clinical data and adenoma features of recurrent patients after endoscopic polypectomy of colorectal adenomatous polyps from January 2007 to December 2015 in the endoscopy center of the first hospital ofJilin University.The initial endoscopy of colon was regarded as the baseline colonoscopy and the following 9 factors were recorded and researched such as gender,age,condition of bowel preparation of patients,and number,diameter,bottom,pattern,pathological grading,excision type of adenomas.We applied single factor statistical analysis for screening recurrent influencing factors of adenomatous polyps.Then the statistically significant factors by single factors were analyzed by multiariable statistical analysis in order to find independent high-risk factors associated with adenomatous recurrence.Results:1.Study participants included 221 patients,and among them 35 cases were found new adenomas during the follow-up period,with a recurrence rate of 15.84%.The cumulative recurrence rates in 1,3,and 5 years after endoscopic polypectomy of colorectal adenomatous polyps were 3.8%,16.5% and 31.4%,respectively.2.Single factor analysis indicated that recurrence rate had statistical difference among adenomatous diameter(P=0.001),adenomatous pattern(P=0.029),pathological grading(P=0.001),bottom of adenomas(P=0.018),excision type(P=0.001).While no significant difference were seen in gender(P=0.202),age(P=0.054),quality of bowel preparation(P=0.114)and number of adenomas(P=0.332).3.Multi-factor analysis showed that recurrence rate had statistical difference among adenomatous diameter(HR=1.821,P=0.007)and pathological grading of adenomatous(HR=2.082,P=0.014).4.Survival curves showed that the larger diameter and higher pathological grading of adenomatous,the greater possibility of adenomatous recurrence was presented.Conclusion:1.We found that the adenomatous recurrence was associated with diameter,pattern,pathological grading,bottom and excision type of adenomas.2.The diameter and pathological grading of adenomas were independently high-risk factors of adenomatous recurrence.The larger diameter and higherpathological grading of adenomatous,the greater possibility of adenomatous recurrence was presented.3.If a patient meets adenomatous diameter larger than 1 cm and the pathological grading of adenomas shows high-grade neoplasia,then we suggest the patient take a colonoscopy in 21 months after endoscopic polypectomy of colorectal adenomatous.