Colon mucosal neoplasia referred for endoscopic mucosal resection: Recurrence of adenomas and prediction of submucosal invasion

Table 1 Baseline characteristics (n = 500)

Variable	Median	IQR	Frequency	Percent, %
Number of > 20 mm adenomas	1	0
Polyp number	1	0
Size (mm)	30	15
Age (yr)	68	14
Height (cm)	170	15
Weight (kg)	80	25
BMI	28	7.35
Colonoscopy duration (min)	44	30
If blood transfusion, number of units	0	0
Sex
Male			260	52
Female			240	48
ASA
Class 1			14	3
Class 2			350	70
Class 3			136	27
Paris classification
Ip (pedunculated)			34	6.8
0-IIa (flat elevation of mucosa)			316	63.2
0-IIb (flat mucosal change)			68	13.6
0-IIc (flat mucosal depression)			3	0.6
0-IIa + c (flat elevation with central depression)			26	5.2
0-IIa + Is (flat elevation with raised broad based nodule)			53	10.6
Morphology
Granular			260	52
Non-granular			206	41
Mixed			34	7
Kudo Pit Pattern
I			3	1
II			10	2
IIIs			192	38
IIIL			172	34
IV			62	12
V			19	4
IIIs + IIIL			20	4
IIIs + IV			4	1
IIIL + IV			18	4
Location
Rectum (< 5 cm from anus)			4	1
Rectum (> 5 cm from anus)			31	6
Sigmoid			45	9
Descending colon			25	5
Splenic flexure			6	1
Transverse			65	13
Hepatic flexure			39	8
Ascending colon			161	32
Cecum			102	20
Ileocecal valve involved			18	4
Appendiceal orifice involved			4	1
Lesion size
20 mm			89	18
21-30 mm			198	40
31-40 mm			107	21
> 40 mm			106	21

IQR: Inter quartile range; ASA: American Society of Anesthesiology; BMI: Body mass index; ICV: Ileocecal valve.

Table 2 Factors associated with submucosal invasion

Factors	No SMI (%)	SMI (%)	P value
	n = 477	n = 23
Size (mm)	30 (12.38)	40 (18.14)	aP < 0.05
Age (yr)	68 (9.7)	69 (10.6)	0.5288
Height (cm)	170 (10.38)	170 (11.04)	0.9185
Weight (kg)	80 (22.32)	87 (30.74)	0.518
BMI	28 (6.77)	30 (8.3)	0.31
Colonoscopy duration (min)	43 (25.03)	56 (21.49)	0.063
Gender			0.6816
Male	249 (52.2)	11 (47.83)
Female	228 (47.8)	12 (52.17)
ASA			0.6912
1	14 (2.94)	0 (0)
2	333 (69.81)	17 (73.91)
3	130 (27.25)	6 (26.09)
Size group			0.1663
20 mm	86 (18.03)	3 (13.04)
21-30 mm	192 (40.25)	6 (26.09)
31-40 mm	102 (21.38)	5 (21.74)
> 40 mm	97 (20.34)	9 (39.13)
Paris classification			bP < 0.01
Ip (pedunculated)	32 (6.7)	2 (8.7)
0-IIa (flat elevation of mucosa)	308 (64.57)	8 (26.09)
0-IIb (flat mucosal change)	68 (14.25)	0 (0)
0-IIc (flat mucosal depression)	1 (0.21)	2 (0)
0-IIa + c (flat elevation with central depression)	22 (4.61)	4 (17.39)
0-IIa + Is (flat elevation with raised broad based nodule)	46 (9.64)	7 (30.43)
Kudo Pit Pattern			cP < 0.01
I	3 (0.63)	0 (0)
II	10 (2.1)	0 (0)
IIIs	190 (39.83)	2(8.7)
IIIL	164 (34.38)	8 (34.78)
IV	58 (12.16)	4 (17.39)
V	15 (3.14)	4 (17.39)
IIIs + IIIL	18 (3.77)	2 (8.7)
IIIs + IV	4 (0.84)	0 (0)
IIIL + IV, Vn	15 (3.14)	3 (13.04)
Morphology			0.3404
Granular	247 (51.78)	13 (56.52)
Non granular	199 (41.72)	7 (30.43)
Mixed	31 (6.5)	3 (13.04)
Location			0.6017
Rectum (< 5 cm from anus)	4 (0.84)	0 (0)
Rectum (> 5 cm from anus)	27 (5.66)	4 (17.39)
Sigmoid	41 (8.6)	4 (17.39)
Descending colon	24 (5.03)	1 (4.35)
Splenic flexure	6 (1.26)	0 (0)
Transverse	62 (13)	3 (13.04)
Hepatic flexure	38 (7.97)	1 (4.35)
Ascending colon	155 (32.49)	6 (26.09)
Cecum	98 (20.55)	4 (17.39)
Ileocecal valve involved	18 (3.77)	0 (0)
Appendiceal orifice involved	4 (0.84)	0 (0)

Categorical variables were presented as frequency (%). SMI: Submucosal invasion; ICV: Ileocecal valve.

Table 3 Final multiple logistic regression analysis investigating factors associated with submucosal invasion

Factor	Estimate	OR	95%CI	P value
Age	-0.0155	0.985	0.943-1.029	0.4553
Gender
Male	(reference)
Female	0.2196	1.551	0.634-3.947	0.3149
Size group
20 mm	(reference)
21-30 mm	-0.2904	0.852	0.227-3.753	0.5141
31-40 mm	0.0314	1.033	0.25-4.766	0.9082
> 40 mm	0.3512	1.545	0.42-6.813	0.3037
Paris classification
Paris classification 1p	(reference)
Paris classification (IIa, IIa + c, IIa + Is) vs 1p	-0.2608	0.98	0.279-5.193	0.6221
Paris classification IIb vs 1p	-2.1639	0.146	0.001-1.943	0.0406
Paris classification IIc vs 1p	2.6652	18.281	1.366-340.689	aP < 0.05
Kudo Pit Pattern
Others	(reference)
Pattern (IIIL + IV and V)	0.7626	4.596	1.506-12.997	bP < 0.001
Morphology
Granular	(reference)
Non granular	-0.2178	0.761	0.263-2.018	0.5423
Mixed	0.1624	1.113	0.21-4.336	0.7352
Location
Recto sigmoid	(reference)
Proximal colon (Cecum- Descending Colon)	-0.4555	0.402	0.161-1.056	0.0458

OR: Odds ratio; CI: Confidence interval.

Table 4 Multivariable analysis and multiple logistic regression model of factors for recurrence of adenoma

Risk factor for recurrence		Estimate	OR	P value
Lesion size	21-30 mm (reference)	-0.2162	3.081 (0.875-10.849)	0.386
Lesion size	31-40 mm vs Reference	0.1644	4.509 (1.227-16.572)	0.5467
Lesion size	> 40 mm vs Reference	1.3935	15.412 (4.292-55.338)	aP < 0.0001
Morphology	Non-Granular vs Granular (reference)	-0.2396	1.087 (0.599-1.97)	0.2681
Morphology	Mixed vs Granular (reference)	0.5623	2.423 (0.978-6.002)	0.0573

OR: Odds ratio.