PURPOSE: The identification of groups with a high risk of colorectal adenoma recurrence remains a controversial issue for clinicians. This study was designed to assess the predictive value of initial patient and adenoma characteristics of the three-year recurrence. METHODS: The study population was composed of 552 patients with resected colorectal adenomas who completed the European Fiber-Calcium Intervention trial. At both baseline and three-year examinations, the characteristics of adenomas were recorded according to a standardized protocol. The main outcomes measured were the three-year overall recurrence, recurrence of multiple adenomas, recurrence of advanced adenomas (size > or = 1 cm or tubulovillous/villous architecture or moderate/severe dysplasia), and proximal and distal recurrence. RESULTS: A three-year recurrence was observed in 122 patients (22.1 percent), and more than one-half of them had recurrent adenomas on the proximal colon. After adjustment for patient characteristics and treatment allocation, the number of adenomas and their proximal location at baseline were the main predictors of recurrence. In comparison with patients who had one or two adenomas on the distal colon, patients with three or more adenomas with at least one of them located on the proximal colon had a much higher risk of overall recurrence (5.3; 95 percent confidence interval, 2.7-10.3), proximal recurrence (8.5; 95 percent confidence interval, 4.1-18), and advanced adenoma recurrence (5.5; 95 percent confidence interval, 2.4-12.6). CONCLUSIONS: Follow-up colonoscopies in patients with adenomas should include careful examination of the proximal colon. The time interval between follow-up examinations could probably be extended beyond three years in patients who have only one or two distal adenomas.
RCT Entities:
PURPOSE: The identification of groups with a high risk of colorectal adenoma recurrence remains a controversial issue for clinicians. This study was designed to assess the predictive value of initial patient and adenoma characteristics of the three-year recurrence. METHODS: The study population was composed of 552 patients with resected colorectal adenomas who completed the European Fiber-Calcium Intervention trial. At both baseline and three-year examinations, the characteristics of adenomas were recorded according to a standardized protocol. The main outcomes measured were the three-year overall recurrence, recurrence of multiple adenomas, recurrence of advanced adenomas (size > or = 1 cm or tubulovillous/villous architecture or moderate/severe dysplasia), and proximal and distal recurrence. RESULTS: A three-year recurrence was observed in 122 patients (22.1 percent), and more than one-half of them had recurrent adenomas on the proximal colon. After adjustment for patient characteristics and treatment allocation, the number of adenomas and their proximal location at baseline were the main predictors of recurrence. In comparison with patients who had one or two adenomas on the distal colon, patients with three or more adenomas with at least one of them located on the proximal colon had a much higher risk of overall recurrence (5.3; 95 percent confidence interval, 2.7-10.3), proximal recurrence (8.5; 95 percent confidence interval, 4.1-18), and advanced adenoma recurrence (5.5; 95 percent confidence interval, 2.4-12.6). CONCLUSIONS: Follow-up colonoscopies in patients with adenomas should include careful examination of the proximal colon. The time interval between follow-up examinations could probably be extended beyond three years in patients who have only one or two distal adenomas.
Authors: María Elena Martínez; John A Baron; David A Lieberman; Arthur Schatzkin; Elaine Lanza; Sidney J Winawer; Ann G Zauber; Ruiyun Jiang; Dennis J Ahnen; John H Bond; Timothy R Church; Douglas J Robertson; Stephanie A Smith-Warner; Elizabeth T Jacobs; David S Alberts; E Robert Greenberg Journal: Gastroenterology Date: 2008-12-09 Impact factor: 22.682
Authors: Hamzah Abu-Sbeih; Ellie Chen; Osman Ahmed; Niharika Mallepally; Phillip Lum; Wei Qiao; Hun Ju Lee; Robert Bresalier; Lan Sun Wang; Brian Weston; Gottumukkala S Raju; Yinghong Wang Journal: Dig Dis Sci Date: 2019-05-03 Impact factor: 3.199
Authors: Heiko Pohl; Douglas J Robertson; Leila A Mott; Dennis J Ahnen; Carol A Burke; Elizabeth L Barry; Robert S Bresalier; Jane C Figueiredo; Aasma Shaukat; Robert S Sandler; John A Baron Journal: Gastrointest Endosc Date: 2016-03-11 Impact factor: 9.427
Authors: Douglas J Robertson; Carol A Burke; H Gilbert Welch; Robert W Haile; Robert S Sandler; E Robert Greenberg; Dennis J Ahnen; Robert S Bresalier; Richard I Rothstein; Bernard Cole; Leila A Mott; John A Baron Journal: Ann Intern Med Date: 2009-07-21 Impact factor: 25.391
Authors: Jocelyne Miller; Neil Mehta; Michael Feldman; Emma Furth; Gregory G Ginsberg; Yu-Xiao Yang; James D Lewis Journal: J Clin Gastroenterol Date: 2010-03 Impact factor: 3.062