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Showing content from https://pubmed.ncbi.nlm.nih.gov/28219690/ below:

Factors Associated With Shorter Colonoscopy Surveillance Intervals for Patients With Low-Risk Colorectal Adenomas and Effects on Outcome

Randomized Controlled Trial

. 2017 Jun;152(8):1933-1943.e5. doi: 10.1053/j.gastro.2017.02.010. Epub 2017 Feb 20. Factors Associated With Shorter Colonoscopy Surveillance Intervals for Patients With Low-Risk Colorectal Adenomas and Effects on Outcome John A Baron², Dennis J Ahnen³, Elizabeth L Barry⁴, Roberd M Bostick⁵, Carol A Burke⁶, Robert S Bresalier⁷, Timothy R Church⁸, Bernard F Cole⁹, Marcia Cruz-Correa¹⁰, Adam S Kim¹¹, Leila A Mott⁴, Robert S Sandler¹², Douglas J Robertson¹³

Affiliations

¹ Department of Medicine, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Electronic address: joseph.anderson@dartmouth.edu.
² Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Medicine in the Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
³ Department of Medicine in the Division of Gastroenterology and Hepatology, University of Colorado School of Medicine and Gastroenterology of the Rockies, Denver and Boulder, Colorado.
⁴ Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
⁵ Department of Epidemiology, Rollins School of Public Health, and Winship Cancer Institute, Emory University, Atlanta, Georgia.
⁶ Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
⁷ Department of Medicine in the Division of Gastroenterology and Hepatology, University of Texas MD Anderson Cancer Center, Houston, Texas.
⁸ Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.
⁹ Interim Dean and Professor of Statistics in the College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont.
¹⁰ Department of Medicine in the Division of Gastroenterology and Hepatology, University of Puerto Rico, San Juan, Puerto Rico.
¹¹ Minnesota Gastroenterology, P.A., Minneapolis, Minnesota.
¹² Department of Medicine in the Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
¹³ Department of Medicine, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

PMID: 28219690
PMCID: PMC6251057
DOI: 10.1053/j.gastro.2017.02.010

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Randomized Controlled Trial

Factors Associated With Shorter Colonoscopy Surveillance Intervals for Patients With Low-Risk Colorectal Adenomas and Effects on Outcome

Joseph C Anderson et al. Gastroenterology. 2017 Jun.

. 2017 Jun;152(8):1933-1943.e5. doi: 10.1053/j.gastro.2017.02.010. Epub 2017 Feb 20. Authors Joseph C Anderson¹, John A Baron², Dennis J Ahnen³, Elizabeth L Barry⁴, Roberd M Bostick⁵, Carol A Burke⁶, Robert S Bresalier⁷, Timothy R Church⁸, Bernard F Cole⁹, Marcia Cruz-Correa¹⁰, Adam S Kim¹¹, Leila A Mott⁴, Robert S Sandler¹², Douglas J Robertson¹³ Affiliations

¹ Department of Medicine, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Electronic address: joseph.anderson@dartmouth.edu.
² Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Medicine in the Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
³ Department of Medicine in the Division of Gastroenterology and Hepatology, University of Colorado School of Medicine and Gastroenterology of the Rockies, Denver and Boulder, Colorado.
⁴ Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
⁵ Department of Epidemiology, Rollins School of Public Health, and Winship Cancer Institute, Emory University, Atlanta, Georgia.
⁶ Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
⁷ Department of Medicine in the Division of Gastroenterology and Hepatology, University of Texas MD Anderson Cancer Center, Houston, Texas.
⁸ Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.
⁹ Interim Dean and Professor of Statistics in the College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont.
¹⁰ Department of Medicine in the Division of Gastroenterology and Hepatology, University of Puerto Rico, San Juan, Puerto Rico.
¹¹ Minnesota Gastroenterology, P.A., Minneapolis, Minnesota.
¹² Department of Medicine in the Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
¹³ Department of Medicine, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

PMID: 28219690
PMCID: PMC6251057
DOI: 10.1053/j.gastro.2017.02.010

Item in Clipboard

Abstract

Background & aims: Endoscopists do not routinely follow guidelines to survey individuals with low-risk adenomas (LRAs; 1-2 small tubular adenomas, < 1 cm) every 5-10 years for colorectal cancer; many recommend shorter surveillance intervals for these individuals. We aimed to identify the reasons that endoscopists recommend shorter surveillance intervals for some individuals with LRAs and determine whether timing affects outcomes at follow-up examinations.

Methods: We collected data from 1560 individuals (45-75 years old) who participated in a prospective chemoprevention trial (of vitamin D and calcium) from 2004 through 2008. Participants in the trial had at least 1 adenoma, detected at their index colonoscopy, and were recommended to receive follow-up colonoscopy examinations at 3 or 5 years after adenoma identification, as recommended by the endoscopist. For this analysis we collected data from only participants with LRAs. These data included characteristics of participants and endoscopists and findings from index and follow-up colonoscopies. Primary endpoints were frequency of recommending shorter (3-year) vs longer (5-year) surveillance intervals, factors associated with these recommendations, and effect on outcome, determined at the follow-up colonoscopy.

Results: A 3-year surveillance interval was recommended for 594 of the subjects (38.1%). Factors most significantly associated with recommendation of 3-year vs a 5-year surveillance interval included African American race (relative risk [RR] to white, 1.41; 95% confidence interval [CI], 1.14-1.75), Asian/Pacific Islander ethnicity (RR to white, 1.7; 95% CI, 1.22-2.43), detection of 2 adenomas at the index examination (RR vs 1 adenoma, 1.47; 95% CI, 1.27-1.71), more than 3 serrated polyps at the index examination (RR=2.16, 95% CI, 1.59-2.93), or index examination with fair or poor quality bowel preparation (RR vs excellent quality, 2.16; 95% CI, 1.66-2.83). Other factors that had a significant association with recommendation for a 3-year surveillance interval included family history of colorectal cancer and detection of 1-2 serrated polyps at the index examination. In comparisons of outcomes, we found no significant differences between the 3-year vs 5-year recommendation groups in proportions of subjects found to have 1 or more adenomas (38.8% vs 41.7% respectively; P = .27), advanced adenomas (7.7% vs 8.2%; P = .73) or clinically significant serrated polyps (10.0% vs 10.3%; P = .82) at the follow-up colonoscopy.

Conclusions: Possibly influenced by patients' family history, race, quality of bowel preparation, or number or size of polyps, endoscopists frequently recommend 3-year surveillance intervals instead of guideline-recommended intervals of 5 years or longer for individuals with LRAs. However, at the follow-up colonoscopy, similar proportions of participants have 1 or more adenomas, advanced adenomas, or serrated polyps. These findings support the current guideline recommendations of performing follow-up examinations of individuals with LRAs at least 5 years after the index colonoscopy.

Keywords: Colon Cancer; Detection; Progression; Tumor Development.

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Conflict of interest statement

Conflicts of interest

The authors disclose no conflicts.

Figures
Figure 1.

Derivation of the low risk…

Figure 1.

Derivation of the low risk adenoma cohort from the parent Vitamin D/Calcium Polyp…

Figure 1.

Derivation of the low risk adenoma cohort from the parent Vitamin D/Calcium Polyp Prevention Trial.

Figure 2.

Variation of 3-year recommendation for…

Figure 2.

Variation of 3-year recommendation for subjects with LRAs on index exam by center.

Figure 2.

Variation of 3-year recommendation for subjects with LRAs on index exam by center.

Figure 3.

Outcomes at follow-up colonoscopy for…

Figure 3.

Outcomes at follow-up colonoscopy for participants with surveillance exams reommended at 3 vs…

Figure 3.

Outcomes at follow-up colonoscopy for participants with surveillance exams reommended at 3 vs 5 years.