Mo1678 EVALUATING RECOMMENDATIONS FOR SURVEILLANCE FOR PATIENTS WITH LOW RISK ADENOMAS

Abstract

Significance: Current practice guidelines recommend surveillance colonoscopies among patients with adenomas removed and intervals vary based on polyp classification. High risk adenomas (HRAs) (≥1 cm, villous features, or high-grade dysplasia) are most likely to progress to cancer and have a recommended 3-year follow-up whereas low risk adenomas (LRAs) (1-2 tubular adenomas ≤1 cm), have a recommended surveillance interval of 5-10 years. Over-performance of surveillance colonoscopies in patients with LRAs increases medical risk and carries significant societal cost. This study examined surveillance recommendations in practice for low risk adenomas. A retrospective chart review in an academic health system of 284 participants [median age: 57.4 (41.6-75.2); 54.6% female] with 1-2 tubular adenomas ≤1 centimeter on index colonoscopy, and a completed surveillance colonoscopy, was performed. Data were collected from exams between January 2011-June 2019. Exclusion criteria included family history of colon cancer, or personal history of polyps, inflammatory bowel disease, adenomas, or colon cancer. The recommended follow-up interval at index colonoscopy and surveillance colonoscopy findings were abstracted. Almost half of participants were recommended to follow up in 5 years (43.3%, n=123). Other recommendations were: 3 years (18.7%), “await pathology results” (19.0%), 5-10 years (8.5%), 3-5 years depending on pathology (3.5%), <3 years (3.2%), 3-5 years (1.4%), 10 years (0.7%), and other (1.8%). The median duration (months) between colonoscopies was 60.07 (12.19 – 88.07). On surveillance, number of LRAs discovered varied: zero (52.1%), one (25.0%), two (12.3%), three (4.6%), four (3.2%), five (0.7%), six or more (1.4%), and uncertain (0.7%). Fifteen participants (5.3%) had one HRA and one (0.4%) had two. No colorectal cancer was detected. Variables significantly associated (p<0.05) with adenomas on surveillance exam included older age, recommendation for follow up after index exam, and worse surveillance exam Boston Bowel Preparation Score (BBPS). Variables with no significant association included sex, race, ethnicity, index exam BBPS, quantity of LRAs and hyperplastic polyps on index exam, LRA size, duration of time between index and surveillance exams, diabetes, smoking history, and body mass index. The majority of participants with LRAs at baseline did not develop HRAs between colonoscopies, supporting a longer surveillance interval. No participants developed colon cancer. Although the current recommended interval is 5-10 years, <10% had a surveillance recommendation of 10 years. Many were told to follow up before 5 years. The findings support the current guidelines of performing a surveillance exam after 5-10 years and suggest that there is low risk in waiting to perform a surveillance exam until closer to the 10 year mark.