Brian A Sullivan1,2, Thomas S Redding1, Elizabeth R Hauser1,3, Ziad F Gellad1,2, Xuejun Qin1,3, Samir Gupta4,5, Douglas J Robertson6,7, David G Weiss8, Meghan C O'Leary1, Ashton N Madison1, Kellie J Sims1, Christina D Williams1,2, Julian C Hong1,9, David Lieberman10,11, Dawn Provenzale1,2. 1. Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC, USA. 2. Department of Medicine, Duke University, Durham, NC, USA. 3. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA. 4. Veterans Affairs San Diego Healthcare System, San Diego, CA, USA. 5. Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA. 6. White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA. 7. Geisel School of Medicine at Dartmouth, Hanover, NH, USA. 8. Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, MD, USA. 9. Department of Radiation Oncology and Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA. 10. Veterans Affairs Portland Health Care System, Portland, OR, USA. 11. Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA.
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.
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.