Risk of advanced colorectal neoplasia at follow-up colonoscopy after synchronous adenoma and clinically significant serrated polyp
Date
2025
Authors
Laven-Law, G.
Symonds, E.L.
Simpson, K.
Coats, M.
De Silva, M.
Hollington, P.
Cock, C.
Wassie, M.M.
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Journal Title
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Journal article
Citation
Clinical Gastroenterology and Hepatology, 2025; 1-10
Statement of Responsibility
Geraldine Laven-Law, Erin L. Symonds, Kalindra Simpson, Michelle Coats, Mahinda De Silva, Paul Hollington, Charles Cock, and Molla Mesele Wassie
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Abstract
Background & Aims: Colorectal cancer (CRC) commonly develops from pre-cancerous neoplasia through the adenoma-carcinoma and/or serrated pathways. Individuals with an adenoma or clinically significant serrated polyp (CSSP) are recommended to undergo surveillance colonoscopy to reduce risk of future CRC. However, the risk of CRC after synchronous adenoma and CSSP re mains unclear. We determined the risk of advanced neoplasia (advanced precancerous neoplasia and/or CRC) at follow-up colonoscopy after a synchronous adenoma and CSSP in comparison to other types of neoplasia. Methods: A retrospective analysis was conducted on colonoscopy outcomes between 2010 and 2023 on patients in a South Australian CRC surveillance program. Risk of advanced neoplasia at follow- up colonoscopy was determined based on prior colonoscopy findings using competing-risk regression. Results: A total of 8481 colonoscopy pairs were included. Advanced neoplasia was found in 11% (973/ 8481) of follow-up colonoscopies. Risk of advanced neoplasia was highest in those with advanced synchronous adenoma and CSSP (hazard ratio [HR], 4.71; 95% confidence interval [CI], 3.17–7.00) and those with prior advanced CSSP only (HR, 4.45; 95% CI, 3.31–5.97). Risk was higher in those with prior advanced synchronous adenoma and CSSP when compared with those with prior advanced adenoma only (HR, 3.19; 95% CI, 2.60–3.91). Conclusions: Patients with synchronous adenoma and CSSP may have concurrent adenoma-carcinoma and serrated pathways active and are at higher risk of developing advanced neoplasia compared with those with only adenomas. These results may help guide surveillance colonoscopy guidelines specific for those with synchronous adenoma and CSSP.
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OnlinePubl.
Available online 5 August 2025.
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© 2025 by the AGA Institute