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Digestive Diseases and Sciences

, Volume 61, Issue 6, pp 1661–1668 | Cite as

Risk of Advanced Colorectal Neoplasia According to the Number of High-Risk Findings at Index Colonoscopy: A Korean Association for the Study of Intestinal Disease (KASID) Study

  • Yoon Suk Jung
  • Dong Il ParkEmail author
  • Won Hee KimEmail author
  • Chang Soo Eun
  • Soo-Kyung Park
  • Bong Min Ko
  • Geom Seog Seo
  • Jae Myung Cha
  • Jae Jun Park
  • Kyeong Ok Kim
  • Chang Mo Moon
  • Yunho Jung
  • Eun Soo Kim
  • Seong Ran Jeon
  • Chang Kyun Lee
Original Article

Abstract

Background

Data regarding outcomes for patients with multiple findings for high-risk adenomas are scarce.

Aim

To compare the risk for colorectal neoplasm (CRN) recurrence according to the number of high-risk findings.

Methods

This was a retrospective and multicenter study. Patients who had one or more high-risk adenomas at the index colonoscopy and underwent follow-up colonoscopy 2.5 or more years after the index colonoscopy were included. The number of high-risk findings was defined as follows: number of adenomas larger than 1 cm + number of adenomas with HGD + number of adenomas with a villous component + existence (counted as 1) or nonexistence (counted as 0) of three or more adenomas.

Results

A total of 1646 patients were included, and the mean duration between index and follow-up colonoscopy was approximately 4 years. The cumulative incidence rate of recurrent advanced CRN in patients with three or more high-risk findings was higher than that in patients with one or two high-risk findings (p < 0.001). However, the difference in 3-year cumulative incidence rates of recurrent advanced CRN between the two groups was not great, although it was statistically significant (4.8 vs. 2.3 %, p = 0.039).

Conclusions

A 3-year surveillance interval for patients with multiple high-risk findings, regardless of the number of high-risk findings, appears reasonable.

Keywords

Colonoscopy High-risk adenoma Colorectal neoplasia Recurrence 

Notes

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Kim ER, Kim YH. Clinical application of genetics in management of colorectal cancer. Intest Res. 2014;12:184–193.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Cha JM. Colonoscopy quality is the answer for the emerging issue of interval cancer. Intest Res. 2014;12:110–116.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–1981.CrossRefPubMedGoogle Scholar
  4. 4.
    Baxter NN, Goldwasser MA, Paszat LF, et al. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009;150:1–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Lin OS, Kozarek RA, Cha JM. Impact of sigmoidoscopy and colonoscopy on colorectal cancer incidence and mortality: an evidence-based review of published prospective and retrospective studies. Intest Res. 2014;12:268–274.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844–857.CrossRefPubMedGoogle Scholar
  7. 7.
    Martinez ME, Sampliner R, Marshall JR, et al. Adenoma characteristics as risk factors for recurrence of advanced adenomas. Gastroenterology. 2001;120:1077–1083.CrossRefPubMedGoogle Scholar
  8. 8.
    Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007;133:1077–1085.CrossRefPubMedGoogle Scholar
  9. 9.
    Martinez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology. 2009;136:832–841.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Martinez ME, Thompson P, Messer K, et al. One-year risk for advanced colorectal neoplasia: U.S. versus U.K. risk-stratification guidelines. Ann Intern Med. 2012;157:856–864.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Wen CP, David Cheng TY, Tsai SP, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 2009;12:497–506.CrossRefPubMedGoogle Scholar
  12. 12.
    Bonithon-Kopp C, Piard F, Fenger C, et al. Colorectal adenoma characteristics as predictors of recurrence. Dis Colon Rectum. 2004;47:323–333.CrossRefPubMedGoogle Scholar
  13. 13.
    Winawer SJ, Zauber AG, O’Brien MJ, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med. 1993;328:901–906.CrossRefPubMedGoogle Scholar
  14. 14.
    Chung SJ, Kim YS, Yang SY, et al. Five-year risk for advanced colorectal neoplasia after initial colonoscopy according to the baseline risk stratification: a prospective study in 2452 asymptomatic Koreans. Gut. 2011;60:1537–1543.CrossRefPubMedGoogle Scholar
  15. 15.
    Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658–662.CrossRefPubMedGoogle Scholar
  16. 16.
    Noshirwani KC, van Stolk RU, Rybicki LA, et al. Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy. Gastrointest Endosc. 2000;51:433–437.CrossRefPubMedGoogle Scholar
  17. 17.
    Seo JY, Chun J, Lee C, et al. Novel risk stratification for recurrence after endoscopic resection of advanced colorectal adenoma. Gastrointest Endosc. 2015;81:655–664.CrossRefPubMedGoogle Scholar
  18. 18.
    Nusko G, Mansmann U, Kirchner T, et al. Risk related surveillance following colorectal polypectomy. Gut. 2002;51:424–428.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Woodward TA, Heckman MG, Cleveland P, et al. Predictors of complete endoscopic mucosal resection of flat and depressed gastrointestinal neoplasia of the colon. Am J Gastroenterol. 2012;107:650–654.CrossRefPubMedGoogle Scholar
  20. 20.
    Mannath J, Subramanian V, Singh R, et al. Polyp recurrence after endoscopic mucosal resection of sessile and flat colonic adenomas. Dig Dis Sci. 2011;56:2389–2395.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Yoon Suk Jung
    • 1
  • Dong Il Park
    • 1
    Email author
  • Won Hee Kim
    • 2
    Email author
  • Chang Soo Eun
    • 3
  • Soo-Kyung Park
    • 1
  • Bong Min Ko
    • 4
  • Geom Seog Seo
    • 5
  • Jae Myung Cha
    • 6
  • Jae Jun Park
    • 7
  • Kyeong Ok Kim
    • 8
  • Chang Mo Moon
    • 9
  • Yunho Jung
    • 10
  • Eun Soo Kim
    • 11
  • Seong Ran Jeon
    • 12
  • Chang Kyun Lee
    • 13
  1. 1.Department of Internal Medicine, Kangbuk Samsung Hospital, School of MedicineSungkyunkwan UniversitySeoulKorea
  2. 2.Digestive Disease Center, CHA Bundang Medical CenterCHA UniversitySeongnam-siKorea
  3. 3.Department of Internal MedicineHanyang University Guri HospitalGuriKorea
  4. 4.Department of Internal Medicine, Digestive Disease Center and Research InstituteSoonchunhyang University School of MedicineBucheonKorea
  5. 5.Department of Internal Medicine, Digestive Disease Research InstituteWonkwang University College of MedicineIksanKorea
  6. 6.Department of Internal Medicine, Kyung Hee University Hospital at Gang DongKyung Hee University School of MedicineSeoulKorea
  7. 7.Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea
  8. 8.Division of Gastroenterology and Hepatology, Department of Internal MedicineYeungnam University College of MedicineDaeguKorea
  9. 9.Department of Internal Medicine, School of MedicineEwha Womans UniversitySeoulKorea
  10. 10.Division of Gastroenterology, Department of MedicineSoonchunhyang University College of MedicineCheonanKorea
  11. 11.Division of Gastroenterology, Department of Internal Medicine, School of MedicineKeimyung UniversityDaeguKorea
  12. 12.Institute for Digestive Research, Digestive Disease Center, College of MedicineSoonchunhyang UniversitySeoulKorea
  13. 13.Department of Internal Medicine, School of MedicineKyung Hee UniversitySeoulKorea

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