TY - JOUR
T1 - High-Risk Adenomas at Screening Colonoscopy Remain Predictive of Future High-Risk Adenomas Despite an Intervening Negative Colonoscopy
AU - Sullivan, Brian A.
AU - Redding, Thomas S.
AU - Hauser, Elizabeth R.
AU - Gellad, Ziad F.
AU - Qin, Xuejun
AU - Gupta, Samir
AU - Robertson, Douglas J.
AU - Weiss, David G.
AU - O'Leary, Meghan C.
AU - Madison, Ashton N.
AU - Sims, Kellie J.
AU - Williams, Christina D.
AU - Hong, Julian C.
AU - Lieberman, David
AU - Provenzale, Dawn
N1 - Funding Information:
Financial support: This work was funded by the US Department of Veteran Affairs Cooperative Studies Program.
Funding Information:
The authors wish to acknowledge the 3,121 veteran participants of CSP #380 and the original CSP #380 site investigators and former team members, Rebecca McNeil and Lawrence Whitley. The authors also wish to acknowledge Veterans Affairs Cooperative Studies Program Director, Grant Huang, PhD, MPH and former Veterans Affairs Office of Research and Development Chief Research and Development Officer, Timothy O'Leary, MD, PhD, for their support of this research.
Publisher Copyright:
© 2020 Wolters Kluwer Health. All rights reserved.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - 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.
AB - 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.
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U2 - 10.14309/ajg.0000000000000677
DO - 10.14309/ajg.0000000000000677
M3 - Article
C2 - 32483010
AN - SCOPUS:85089202921
SN - 0002-9270
VL - 115
SP - 1275
EP - 1282
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 8
ER -