High-Risk Adenomas at Screening Colonoscopy Remain Predictive of Future High-Risk Adenomas Despite an Intervening Negative Colonoscopy. (August 2020)

• Record Type: Journal Article
• Authors: Sullivan, Brian A.; Redding, Thomas S.; Hauser, Elizabeth R.; Gellad, Ziad F.; Qin, Xuejun; Gupta, Samir; Robertson, Douglas J.; Weiss, David G.; O'Leary, Meghan C.; Madison, Ashton N.; Sims, Kellie J.; Williams, Christina D.; Hong, Julian C.; Lieberman, David; Provenzale, Dawn
• Is Part Of: American journal of gastroenterology. Volume 115:Number 8(2020)
• Publication Date: 2020-08
• Subjects: Stomach -- Diseases -- Periodicals; Intestines -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Gastrointestinal Diseases -- Periodicals; Electronic journals; Periodicals; 616.33
• DOI: 10.14309/ajg.0000000000000677
• Languages: English
• ISSNs: 0002-9270

Abstract

Abstract : INTRODUCTION: Limited data inform the current postpolypectomy surveillance guidelines, which suggest a shortened interval to third colonoscopy after a negative second examination if high-risk adenomas (HRA) were present on the initial screening colonoscopy. Therefore, we examined the risk of HRA at third colonoscopy stratified by findings on 2 previous examinations in a prospective screening colonoscopy cohort of US veterans. METHODS: We identified participants who had 3 or more colonoscopies from CSP#380. We examined the risk of HRA on the third examination based on findings from the previous 2 examinations. Multivariate logistic regression was used to adjust for multiple covariates. RESULTS: HRA were found at the third examination in 114 (12.8%) of 891 participants. Those with HRA on both previous examinations had the greatest incidence of HRA at third examination (14/56, 25.0%). Compared with those with no adenomas on both previous examinations, participants with HRA on the first examination remained at significantly increased risk for HRA at the third examination at 3 years after a negative second examination (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.28–9.08), 5 years (OR 3.14, 95% CI 1.49–6.61), and 7 years (OR 2.89, 95% CI 1.08–7.74). DISCUSSION: In a screening population, HRA on the first examination identified individuals who remained at increased risk for HRA at the third examination, even after a negative second examination. This finding supports current colorectal cancer surveillance guidelines, which suggest a shortened, 5-year time interval to third colonoscopy after a negative second examination if high-risk findings were present on the baseline examination.