The Long‐Term Risk of Metachronous Advanced Adenoma Recurrence After Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Propensity‐Score Matched Longitudinal Cohort With 5‐Year Follow‐Up

• Published in: United European gastroenterology journal Vol. 13; no. 2; pp. 210 - 219
• Main Authors: Dai, Min, Xiao, Xiang, Guo, Cosmos L. T., Lui, Rashid N., Yip, Hon Chi, Chu, Simon, Hon, Sok Fei, Ng, Simon S. M., Chiu, Philip W. Y., Ng, Siew C., Chan, Francis K. L., Lau, Louis H. S.
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01.03.2025
• Subjects: Adenoma - epidemiology; Adenoma - pathology; Adenoma - surgery; Aged; Colonoscopy; colorectal cancer; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; CRC; dysplasia; Endoscopic Mucosal Resection - adverse effects; Endoscopic Mucosal Resection - methods; Endoscopy; ESD; Female; Follow-Up Studies; Hong Kong - epidemiology; Humans; Incidence; Longitudinal Studies; Male; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasms, Second Primary - epidemiology; Neoplasms, Second Primary - pathology; Original; polypectomy; polyps; Propensity Score; Retrospective Studies; risk; Risk Assessment; Risk Factors; surveillance; Time Factors; USMSTF; Hong Kong; dysplasia; polyps; colorectal cancer; CRC; ESD; USMSTF; polypectomy; risk; surveillance; colonoscopy
• ISSN: 2050-6406; 2050-6414; 2050-6414
• DOI: 10.1002/ueg2.12735

ABSTRACT Introduction Long‐term data on metachronous advanced adenoma (AA) recurrence after endoscopic submucosal dissection (ESD) remain scarce, leading to a lack of a standardized surveillance strategy. This study aims to evaluate the long‐term risk of recurrent AA after ESD. Materials and Methods A longitudinal retrospective cohort study with propensity‐score matching was conducted in a tertiary hospital in Hong Kong. Subjects who underwent colorectal ESD between 2011 and 2017 were enrolled and defined as the post‐ESD group. Selected subjects who underwent polypectomy in their index colonoscopy between 2011 and 2017 were enrolled and stratified into the low‐ intermediate‐ and the high‐risk groups according to the US Multi‐Society Task Force (USMSTF) guideline. The risks of recurrent AA were assessed by Cox proportional hazards regression in the matched cohorts. Results A total of 1745 subjects were included, with 203 post‐ESD subjects fully matched with 729 high‐risk and 813 low‐intermediate‐risk subjects, respectively. The 5‐year cumulative incidence of recurrent AA in the post‐ESD group was 7.8%. After 5 years, the post‐ESD group was not associated with a higher rate of recurrent AA to the low‐intermediate‐risk group (7.8% vs. 5.5%; adjusted HR [aHR] 1.64, 95% CI 0.77–3.48, p = 0.197) but a lower rate of recurrent AA (7.8% vs. 11.8%; aHR 0.40, 95% CI 0.19–0.85, p = 0.017) than the high‐risk group. Conclusion Subjects who underwent ESD were not associated with an increased 5‐year risk of metachronous AA recurrence than low‐intermediate or high‐risk groups in USMSTF. The findings will inform future guidelines on post‐ESD surveillance colonoscopy strategies.