Abstract
BackgroundSupplementary observational data in the community setting are required to better assess the predictors of colorectal polyp recurrence and the effectiveness of colonoscopy surveillance under real circumstances.AimThe goal of this study was to identify patient characteristics and polyp features at baseline colonoscopy that are associated with the recurrence of colorectal polyps (including hyperplastic polyps) among patients consulting private practice physicians.Patients and MethodsThis cohort study was conducted from March 2004 to December 2010 in 26 private gastroenterology practices (France). It included 1023 patients with a first-time diagnosis of histologically confirmed polyp removed during a diagnostic or screening colonoscopy. At enrollment, interviews were conducted to obtain data on socio-demographic variables and risk factors. Pathology reports were reviewed to abstract data on polyp features at baseline colonoscopy. Colorectal polyps diagnosed at the surveillance colonoscopy were considered as end points. The time to event was analyzed with an accelerated failure time model assuming a Weibull distribution.ResultsAmong the 1023 patients with colorectal polyp at baseline, 553 underwent a surveillance colonoscopy. The mean time interval from baseline colonoscopy to first surveillance examination was 3.42 (standard deviation, 1.45) years. The recurrence rates were 50.5% and 32.9% for all polyps and adenomas, respectively. In multivariate models, the number of polyps at baseline was the only significant predictor for both polyp recurrence (hazard ratio [HR] 1.19, 95% CI 1.06 to 1.33), and adenoma recurrence (HR 1.17, 95% CI 1.03 to 1.34).ConclusionThe efficacy of surveillance colonoscopy in community gastroenterology practice compared favorably with academic settings. This study provides further evidence that the number of initial colorectal polyps is useful for predicting the risk of polyp recurrence, even in the community setting.
Highlights
Most colorectal cancers (CRCs) are believed to develop through a complex multistep process from normal mucosa to benign adenoma and to carcinoma
The number of polyps at baseline was the only significant predictor for both polyp recurrence, and adenoma recurrence (HR 1.17, 95% CI 1.03 to 1.34)
This study provides further evidence that the number of initial colorectal polyps is useful for predicting the risk of polyp recurrence, even in the community setting
Summary
Most colorectal cancers (CRCs) are believed to develop through a complex multistep process from normal mucosa to benign adenoma and to carcinoma. Interrupting this adenomacarcinoma sequence with coloscopy and polypectomy is recommended to prevent CRC. Periodic surveillance examinations are considered necessary after the removal of colorectal polyps because of the risk of newly discovered lesions. Patients with a clean colon after initial polypectomy have a higher risk of developing adenomas than non-polyp carriers [1]. Adenoma recurrence rates vary greatly between studies (approximately 20%–50% within 3–5 years, see reviews [3,4,5]), due to differences in patient characteristics at baseline, the follow up duration, patient compliance, inclusion criteria, and the quality of the initial colonoscopy and polypectomy. Supplementary observational data in the community setting are required to better assess the predictors of colorectal polyp recurrence and the effectiveness of colonoscopy surveillance under real circumstances
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
