A multicenter cohort study found that incomplete polyp removal—polyp removal where neoplastic tissue is found in any of the marginal biopsies—is a likely contributor to neoplasia recurrence and interval colorectal cancer. The results highlight the critical importance of polyp resection technique in efforts to improve colonoscopy quality. These findings were published by Pohl et al in Annals of Internal Medicine.
Incomplete polyp resection has been estimated to account for up to 30% of all postcolonoscopy colorectal cancer. Cancer is considered to be the result of incomplete resection if it is found in a colon segment with a previous clinically significant polyp. However, there is no standard definition of a clinically significant polyp, and there are no data on the natural history of polyps that were incompletely removed.
Study Findings
Researchers from the VA Medical Center studied medical records for 233 participants in the Complete Adenoma REsection (CARE) study to examine the risk for metachronous neoplasia during surveillance colonoscopy after documented incomplete polyp resection. Patients with a documented incomplete polyp resection on the marginal biopsies were recommended to have a surveillance examination within 1 year. All other patients were provided with surveillance recommendations per endoscopists based on current guidelines.
Of 233 participants in the original study, 166 (71%) had at least one surveillance examination. The researchers found that incomplete segments (those with a prior incompletely removed polyp) were more likely to have metachronous neoplasia than complete segments (52% vs 23%) and were also more likely to harbor advanced neoplasia (18% vs 3%). Moreover, incomplete resection was the strongest independent factor associated with metachronous neoplasia (odds ratio = 3.0, 95% confidence interval = 1.12–8.17).
According to the authors, these findings suggest that further work to improve polypectomy technique through training and quality assurance type monitoring is warranted.
They concluded, “This natural history study found a statistically significantly greater risk for future neoplasia and advanced neoplasia in colon segments after incomplete resection compared with segments with complete resection.”
Disclosure: For full disclosures of the study authors, visit acpjournals.org.
