One-year risk for advanced colorectal neoplasia: U.S. Versus U.K. risk-stratification guidelines

María Elena Martínez, Patricia Thompson, Karen Messer, Erin L. Ashbeck, David Lieberman, John A. Baron, Dennis J. Ahnen, Douglas J. Robertson, Elizabeth T. Jacobs, E. Robert Greenberg, Amanda J. Cross, Wendy Atkin

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Abstract

Background: Guidelines from the United Kingdom and the United States on risk stratification after polypectomy differ, as do recommended surveillance intervals. Objective: To compare risk for advanced colorectal neoplasia at 1-year colonoscopy among patients cross-classified by U.S. and U.K. surveillance guidelines. Design: Pooled analysis of 4 prospective studies between 1984 and 1998. Setting: Academic and private clinics in the United States. Patients: 3226 postpolypectomy patients with 6- to 18-month follow-up colonoscopy. Measurements: Rates of advanced neoplasia (an adenoma ≥1 cm, high-grade dysplasia, >25% villous architecture, or invasive cancer) at 1 year, compared across U.S. and U.K. risk categories. Results: Advanced neoplasia was detected 1 year after polypectomy in 3.8% (95% CI, 2.7% to 4.9%) of lower-risk patients and 11.2% (CI, 9.8% to 12.6%) of higher-risk patients by U.S. criteria. According to U.K. criteria, 4.4% (CI, 3.3% to 5.4%) of low-risk patients, 9.9% (CI, 8.3% to 11.5%) of intermediate-risk patients, and 18.7% (CI, 14.8% to 22.5%) of high-risk patients presented with advanced neoplasia; U.K. high-risk patients comprised 12.1% of all patients. All U.S. lower-risk patients were low-risk by U.K. criteria; however, more patients were classified as low-risk, because the U.K. guidelines do not consider histologic features. Higher-risk U.S. patients were distributed across the 3 U.K. categories. Among all patients with advanced neoplasia, 26.3% were reclassified by the U.K. criteria to a higher-risk category and 7.0% to a lower-risk category, with a net 19.0% benefiting from detection 2 years earlier. Overall, substitution of U.K. for U.S. guidelines resulted in an estimated 0.03 additional colonoscopy every 5 years per patient. Limitations: Patients were enrolled 15 to 20 years ago, and quality measures for colonoscopy were unavailable. Patients lacking follow-up colonoscopy or with surveillance colonoscopy after 6 to 18 months and those with cancer or insufficient baseline adenoma characteristics were excluded (2076 of 5302). Conclusion: Application of the U.K. guidelines in the United States could identify a subset of high-risk patients who may warrant a 1-year clearing colonoscopy without substantially increasing rates of colonoscopy.

Original languageEnglish (US)
Pages (from-to)856-864
Number of pages9
JournalAnnals of Internal Medicine
Volume157
Issue number12
StatePublished - Dec 18 2012

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Guidelines
Colonoscopy
Neoplasms
Adenoma
Prospective Studies

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Martínez, M. E., Thompson, P., Messer, K., Ashbeck, E. L., Lieberman, D., Baron, J. A., ... Atkin, W. (2012). One-year risk for advanced colorectal neoplasia: U.S. Versus U.K. risk-stratification guidelines. Annals of Internal Medicine, 157(12), 856-864.

One-year risk for advanced colorectal neoplasia : U.S. Versus U.K. risk-stratification guidelines. / Martínez, María Elena; Thompson, Patricia; Messer, Karen; Ashbeck, Erin L.; Lieberman, David; Baron, John A.; Ahnen, Dennis J.; Robertson, Douglas J.; Jacobs, Elizabeth T.; Robert Greenberg, E.; Cross, Amanda J.; Atkin, Wendy.

In: Annals of Internal Medicine, Vol. 157, No. 12, 18.12.2012, p. 856-864.

Research output: Contribution to journalArticle

Martínez, ME, Thompson, P, Messer, K, Ashbeck, EL, Lieberman, D, Baron, JA, Ahnen, DJ, Robertson, DJ, Jacobs, ET, Robert Greenberg, E, Cross, AJ & Atkin, W 2012, 'One-year risk for advanced colorectal neoplasia: U.S. Versus U.K. risk-stratification guidelines', Annals of Internal Medicine, vol. 157, no. 12, pp. 856-864.
Martínez ME, Thompson P, Messer K, Ashbeck EL, Lieberman D, Baron JA et al. One-year risk for advanced colorectal neoplasia: U.S. Versus U.K. risk-stratification guidelines. Annals of Internal Medicine. 2012 Dec 18;157(12):856-864.
Martínez, María Elena ; Thompson, Patricia ; Messer, Karen ; Ashbeck, Erin L. ; Lieberman, David ; Baron, John A. ; Ahnen, Dennis J. ; Robertson, Douglas J. ; Jacobs, Elizabeth T. ; Robert Greenberg, E. ; Cross, Amanda J. ; Atkin, Wendy. / One-year risk for advanced colorectal neoplasia : U.S. Versus U.K. risk-stratification guidelines. In: Annals of Internal Medicine. 2012 ; Vol. 157, No. 12. pp. 856-864.
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title = "One-year risk for advanced colorectal neoplasia: U.S. Versus U.K. risk-stratification guidelines",
abstract = "Background: Guidelines from the United Kingdom and the United States on risk stratification after polypectomy differ, as do recommended surveillance intervals. Objective: To compare risk for advanced colorectal neoplasia at 1-year colonoscopy among patients cross-classified by U.S. and U.K. surveillance guidelines. Design: Pooled analysis of 4 prospective studies between 1984 and 1998. Setting: Academic and private clinics in the United States. Patients: 3226 postpolypectomy patients with 6- to 18-month follow-up colonoscopy. Measurements: Rates of advanced neoplasia (an adenoma ≥1 cm, high-grade dysplasia, >25{\%} villous architecture, or invasive cancer) at 1 year, compared across U.S. and U.K. risk categories. Results: Advanced neoplasia was detected 1 year after polypectomy in 3.8{\%} (95{\%} CI, 2.7{\%} to 4.9{\%}) of lower-risk patients and 11.2{\%} (CI, 9.8{\%} to 12.6{\%}) of higher-risk patients by U.S. criteria. According to U.K. criteria, 4.4{\%} (CI, 3.3{\%} to 5.4{\%}) of low-risk patients, 9.9{\%} (CI, 8.3{\%} to 11.5{\%}) of intermediate-risk patients, and 18.7{\%} (CI, 14.8{\%} to 22.5{\%}) of high-risk patients presented with advanced neoplasia; U.K. high-risk patients comprised 12.1{\%} of all patients. All U.S. lower-risk patients were low-risk by U.K. criteria; however, more patients were classified as low-risk, because the U.K. guidelines do not consider histologic features. Higher-risk U.S. patients were distributed across the 3 U.K. categories. Among all patients with advanced neoplasia, 26.3{\%} were reclassified by the U.K. criteria to a higher-risk category and 7.0{\%} to a lower-risk category, with a net 19.0{\%} benefiting from detection 2 years earlier. Overall, substitution of U.K. for U.S. guidelines resulted in an estimated 0.03 additional colonoscopy every 5 years per patient. Limitations: Patients were enrolled 15 to 20 years ago, and quality measures for colonoscopy were unavailable. Patients lacking follow-up colonoscopy or with surveillance colonoscopy after 6 to 18 months and those with cancer or insufficient baseline adenoma characteristics were excluded (2076 of 5302). Conclusion: Application of the U.K. guidelines in the United States could identify a subset of high-risk patients who may warrant a 1-year clearing colonoscopy without substantially increasing rates of colonoscopy.",
author = "Mart{\'i}nez, {Mar{\'i}a Elena} and Patricia Thompson and Karen Messer and Ashbeck, {Erin L.} and David Lieberman and Baron, {John A.} and Ahnen, {Dennis J.} and Robertson, {Douglas J.} and Jacobs, {Elizabeth T.} and {Robert Greenberg}, E. and Cross, {Amanda J.} and Wendy Atkin",
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T1 - One-year risk for advanced colorectal neoplasia

T2 - U.S. Versus U.K. risk-stratification guidelines

AU - Martínez, María Elena

AU - Thompson, Patricia

AU - Messer, Karen

AU - Ashbeck, Erin L.

AU - Lieberman, David

AU - Baron, John A.

AU - Ahnen, Dennis J.

AU - Robertson, Douglas J.

AU - Jacobs, Elizabeth T.

AU - Robert Greenberg, E.

AU - Cross, Amanda J.

AU - Atkin, Wendy

PY - 2012/12/18

Y1 - 2012/12/18

N2 - Background: Guidelines from the United Kingdom and the United States on risk stratification after polypectomy differ, as do recommended surveillance intervals. Objective: To compare risk for advanced colorectal neoplasia at 1-year colonoscopy among patients cross-classified by U.S. and U.K. surveillance guidelines. Design: Pooled analysis of 4 prospective studies between 1984 and 1998. Setting: Academic and private clinics in the United States. Patients: 3226 postpolypectomy patients with 6- to 18-month follow-up colonoscopy. Measurements: Rates of advanced neoplasia (an adenoma ≥1 cm, high-grade dysplasia, >25% villous architecture, or invasive cancer) at 1 year, compared across U.S. and U.K. risk categories. Results: Advanced neoplasia was detected 1 year after polypectomy in 3.8% (95% CI, 2.7% to 4.9%) of lower-risk patients and 11.2% (CI, 9.8% to 12.6%) of higher-risk patients by U.S. criteria. According to U.K. criteria, 4.4% (CI, 3.3% to 5.4%) of low-risk patients, 9.9% (CI, 8.3% to 11.5%) of intermediate-risk patients, and 18.7% (CI, 14.8% to 22.5%) of high-risk patients presented with advanced neoplasia; U.K. high-risk patients comprised 12.1% of all patients. All U.S. lower-risk patients were low-risk by U.K. criteria; however, more patients were classified as low-risk, because the U.K. guidelines do not consider histologic features. Higher-risk U.S. patients were distributed across the 3 U.K. categories. Among all patients with advanced neoplasia, 26.3% were reclassified by the U.K. criteria to a higher-risk category and 7.0% to a lower-risk category, with a net 19.0% benefiting from detection 2 years earlier. Overall, substitution of U.K. for U.S. guidelines resulted in an estimated 0.03 additional colonoscopy every 5 years per patient. Limitations: Patients were enrolled 15 to 20 years ago, and quality measures for colonoscopy were unavailable. Patients lacking follow-up colonoscopy or with surveillance colonoscopy after 6 to 18 months and those with cancer or insufficient baseline adenoma characteristics were excluded (2076 of 5302). Conclusion: Application of the U.K. guidelines in the United States could identify a subset of high-risk patients who may warrant a 1-year clearing colonoscopy without substantially increasing rates of colonoscopy.

AB - Background: Guidelines from the United Kingdom and the United States on risk stratification after polypectomy differ, as do recommended surveillance intervals. Objective: To compare risk for advanced colorectal neoplasia at 1-year colonoscopy among patients cross-classified by U.S. and U.K. surveillance guidelines. Design: Pooled analysis of 4 prospective studies between 1984 and 1998. Setting: Academic and private clinics in the United States. Patients: 3226 postpolypectomy patients with 6- to 18-month follow-up colonoscopy. Measurements: Rates of advanced neoplasia (an adenoma ≥1 cm, high-grade dysplasia, >25% villous architecture, or invasive cancer) at 1 year, compared across U.S. and U.K. risk categories. Results: Advanced neoplasia was detected 1 year after polypectomy in 3.8% (95% CI, 2.7% to 4.9%) of lower-risk patients and 11.2% (CI, 9.8% to 12.6%) of higher-risk patients by U.S. criteria. According to U.K. criteria, 4.4% (CI, 3.3% to 5.4%) of low-risk patients, 9.9% (CI, 8.3% to 11.5%) of intermediate-risk patients, and 18.7% (CI, 14.8% to 22.5%) of high-risk patients presented with advanced neoplasia; U.K. high-risk patients comprised 12.1% of all patients. All U.S. lower-risk patients were low-risk by U.K. criteria; however, more patients were classified as low-risk, because the U.K. guidelines do not consider histologic features. Higher-risk U.S. patients were distributed across the 3 U.K. categories. Among all patients with advanced neoplasia, 26.3% were reclassified by the U.K. criteria to a higher-risk category and 7.0% to a lower-risk category, with a net 19.0% benefiting from detection 2 years earlier. Overall, substitution of U.K. for U.S. guidelines resulted in an estimated 0.03 additional colonoscopy every 5 years per patient. Limitations: Patients were enrolled 15 to 20 years ago, and quality measures for colonoscopy were unavailable. Patients lacking follow-up colonoscopy or with surveillance colonoscopy after 6 to 18 months and those with cancer or insufficient baseline adenoma characteristics were excluded (2076 of 5302). Conclusion: Application of the U.K. guidelines in the United States could identify a subset of high-risk patients who may warrant a 1-year clearing colonoscopy without substantially increasing rates of colonoscopy.

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