Adenoma characteristics at first colonoscopy as predictors of adenoma recurrence and characteristics at follow-up

Abstract

Background & Aims: All patients with colorectal adenomas may not require identical follow-up. We aimed to determine if adenoma characteristics at initial colonoscopy could predict adenoma recurrence or characteristics at follow-up. Methods: The number of adenomas and the size, type, and degree of atypia in 479 patients in a polyp prevention trial were evaluated as predictors of the same characteristics at follow-up using odds ratios (ORs) with 95% confidence intervals (CIs). Multiple logistic regression analysis was performed to determine if several baseline characteristics were simultaneously associated with outcome. Results: Although several characteristics were significant predictors of recurrence univariately, by multivariate analysis, multiple adenomas at follow-up were more likely when patients had ≥3 baseline adenomas (OR, 2.25; 95% CI, 1.20–4.21) or at least 1 tubulovillous adenoma (OR, 2.12; 95% CI, 1.12–4.02). No specific characteristic was associated with recurrence of high-risk polyps (≥1 cm, villous, severe atypia). Seventy percent of patients with 1 or 2 baseline adenomas had no recurrence, and only 3.3% had any adenomas of clinical concern. Conclusions: Number and type of baseline adenomas predict recurrent adenomas, but the recurrence is rarely of clinical concern. Patients with 1 or 2 tubular adenomas constitute a low-risk group for whom follow-up might be extended beyond 3 years. GASTROENTEROLOGY 1998;115:13-18