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Risk factors of nonadherence to colonoscopy surveillance after polypectomy and its impact on clinical outcomes: a KASID multicenter study

  • Original Article—Alimentary Tract
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Abstract

Background

An optimal surveillance program is important to prevent advanced colorectal neoplasm. In this context, we have evaluated the cumulative risk of high-risk adenoma (HRA) or colorectal cancer (CRC) according to surveillance interval time after polypectomy. In addition, we assessed risk factors for late surveillance to determine whether late surveillance can impact the risk of subsequent advanced colorectal neoplasm.

Methods

This was a multicenter retrospective cohort study involving 3562 subjects who had undergone removal of at least one adenoma at the index colonoscopy and who subsequently underwent a surveillance colonoscopy. The subjects were classified into an early, appropriate or late group depending on the timing of the surveillance colonoscopy, performed using modified U.S. guidelines.

Results

With 3% of the study population with LRA and HRA at the index colonoscopy going on to develop HRA or CRC, the estimated surveillance intervals calculated would be 6.3 [95% confidence interval (CI) 5.42–7.10] years and 3.1 (95% CI 2.61–4.45) years, respectively. The predictors of late surveillance were female gender [odd ratio (OR) 1.21; 95% CI 1.04–1.40], having undergone the procedure in small-to-medium-sized cities (OR 1.92; 95% CI 1.36–2.72) and HRA at index colonoscopy (OR 1.37; 95% CI 1.19–1.59). The risk factors for subsequent HRA or CRC were late surveillance (OR 1.34; 95% CI 1.03–1.74), male gender (OR 2.13; 95% CI 1.54–2.95), having undergone the procedure in small-to-medium-sized cities (OR 1.63; 95% CI 1.11–2.40) and HRA at index colonoscopy (OR 2.60; 95% CI 2.04–3.33).

Conclusions

Women, having undergone the procedure in small-to-medium-sized cities and the presence of an HRA at the index colonoscopy were found to be independent risk factors for late surveillance colonoscopy. Late surveillance is significantly predictive of subsequent HRA or CRC.

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Acknowledgements

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (Grant Number, NRF-2014R1A1A2058325) and the Ewha Womans University Research Grant of 2014. The study sponsors had no role in the study design, collection, analyses, interpretation of the data and/or drafting of the manuscript.

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Authors and Affiliations

  1. Department of Health Promotion Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea

    Chung Hyun Tae

  2. Department of Internal Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea

    Chang Mo Moon, Seong-Eun Kim & Sung-Ae Jung

  3. Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea

    Chang Soo Eun

  4. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jae Jun Park

  5. Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Republic of Korea

    Geom Seog Seo

  6. Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Republic of Korea

    Jae Myung Cha

  7. Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea

    Sung Chul Park

  8. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea

    Jaeyoung Chun

  9. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyun Jung Lee

  10. Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea

    Yunho Jung

  11. Department of Internal Medicine, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea

    Jin Oh Kim

  12. Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea

    Young-Eun Joo

  13. Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Dong Il Park

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  1. Chung Hyun Tae
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Correspondence to Chang Mo Moon.

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Tae, C.H., Moon, C.M., Kim, SE. et al. Risk factors of nonadherence to colonoscopy surveillance after polypectomy and its impact on clinical outcomes: a KASID multicenter study. J Gastroenterol 52, 809–817 (2017). https://doi.org/10.1007/s00535-016-1280-3

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  • DOI: https://doi.org/10.1007/s00535-016-1280-3

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