Advertisement

Update in Surveillance Recommendations in Individuals With Conventional Adenomas

  • Rishabh Sachdev
  • Rahul Sao
  • John W. Birk
  • Joseph C. AndersonEmail author
  • Joel Levine
Colon (JC Anderson, Section Editor)
  • 41 Downloads
Part of the following topical collections:
  1. Topical Collection on Colon

Abstract

Purpose of review

Conventional adenomas, which are precursors to almost 70% of colorectal carcinomas, are found in more than one-third of screening colonoscopies. Surveillance recommendations, based on adenoma size, histology, and number, have evolved over the years and are currently reflective of index adenoma categorization as either low-risk (LRA) or high-risk (HRA). In this review, recent guideline recommendations as well as primary data that have helped to shape these recommendations are presented.

Recent findings

Recent data have demonstrated that individuals with HRA on index exams may be at increased risk for CRC while those with LRA may have a minimal long-term risk for CRC, similar to those adults with normal index exams. Furthermore, the quality of the index exams is important for minimizing CRC risk.

Summary

While individuals with HRA may require close surveillance intervals of 3 years, those with LRA or normal exams may need longer such as 10-year follow-up.

Keywords

Colorectal cancer screening Metachronous neoplasia Conventional adenoma Advanced adenoma Surveillance interval 

Notes

Compliance with Ethical Standards

Conflict of Interest

Rishabh Sachdev, Rahul Sao, John W. Birk, Joseph C. Anderson, and Joel Levine declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.CrossRefGoogle Scholar
  2. 2.
    Welch HG, Robertson DJ. Colorectal cancer on the decline--why screening can’t explain it all. N Engl J Med. 2016;374:1605–7.CrossRefGoogle Scholar
  3. 3.
    Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–73.CrossRefGoogle Scholar
  4. 4.
    Rex DK, Hassan C, Bourke MJ. The colonoscopist’s guide to the vocabulary of colorectal neoplasia: histology, morphology, and management. Gastrointest Endosc. 2017;86:253–63.CrossRefGoogle Scholar
  5. 5.
    Brenner H, Hoffmeister M, Stegmaier C, Brenner G, Altenhofen L, Haug U. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840 149 screening colonoscopies. Gut. 2007;56:1585–9.CrossRefGoogle Scholar
  6. 6.
    • Click B, Pinsky PF, Hickey T, Doroudi M, Schoen RE. Association of Colonoscopy Adenoma Findings With Long-term Colorectal Cancer Incidence. JAMA. 2018;319:2021–31 This analysis of data from participants in the prostate, lung, colorectal, and ovarian (PLCO) cancer randomized clinical trial of flexible sigmoidoscopy showed that individuals with advanced adenomas undergoing surveillance had an increased risk for colorectal cancer as compared with those with no adenoma on index exam. Individuals with low-risk adenomas had risk similar to that of those with no adenomas.CrossRefGoogle Scholar
  7. 7.
    Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112:1016–30.CrossRefGoogle Scholar
  8. 8.
    Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M, Italian Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48:812–5.CrossRefGoogle Scholar
  9. 9.
    Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer. 1975;36:2251–70.CrossRefGoogle Scholar
  10. 10.
    Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–81.CrossRefGoogle Scholar
  11. 11.
    Winawer SJ, Zauber AG, O’Brien MJ, Ho MN, Gottlieb L, Sternberg SS, 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;328:901–6.CrossRefGoogle Scholar
  12. 12.
    Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992;326:658–62.CrossRefGoogle Scholar
  13. 13.
    Martinez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology. 2009;136:832–41.CrossRefGoogle Scholar
  14. 14.
    Cottet V, Jooste V, Fournel I, Bouvier AM, Faivre J, Bonithon-Kopp C. Long-term risk of colorectal cancer after adenoma removal: a population-based cohort study. Gut. 2012;61:1180–6.CrossRefGoogle Scholar
  15. 15.
    Loberg M, Kalager M, Holme O, et al. Long-term colorectal-cancer mortality after adenoma removal. N Engl J Med. 2014;371:799–807.CrossRefGoogle Scholar
  16. 16.
    Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844–57.CrossRefGoogle Scholar
  17. 17.
    Lieberman DA, Weiss DG, Harford WV, Ahnen DJ, Provenzale D, Sontag SJ, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007;133:1077–85.CrossRefGoogle Scholar
  18. 18.
    Imperiale TF, Glowinski EA, Lin-Cooper C, Larkin GN, Rogge JD, Ransohoff DF. Five-year risk of colorectal neoplasia after negative screening colonoscopy. N Engl J Med. 2008;359:1218–24.CrossRefGoogle Scholar
  19. 19.
    Brenner H, Haug U, Arndt V, Stegmaier C, Altenhofen L, Hoffmeister M. Low risk of colorectal cancer and advanced adenomas more than 10 years after negative colonoscopy. Gastroenterology. 2010;138:870–6.CrossRefGoogle Scholar
  20. 20.
    Ponugoti PL, Rex DK. Yield of a second screening colonoscopy 10 years after an initial negative examination in average-risk individuals. Gastrointest Endosc. 2017;85:221–4.CrossRefGoogle Scholar
  21. 21.
    Laiyemo AO, Murphy G, Sansbury LB, Wang Z, Albert PS, Marcus PM, et al. Hyperplastic polyps and the risk of adenoma recurrence in the polyp prevention trial. Clin Gastroenterol Hepatol. 2009;7:192–7.CrossRefGoogle Scholar
  22. 22.
    Waye JD, Braunfeld S. Surveillance intervals after colonoscopic polypectomy. Endoscopy. 1982;14:79–81.CrossRefGoogle Scholar
  23. 23.
    Saini SD, Kim HM, Schoenfeld P. Incidence of advanced adenomas at surveillance colonoscopy in patients with a personal history of colon adenomas: a meta-analysis and systematic review. Gastrointest Endosc. 2006;64:614–26.CrossRefGoogle Scholar
  24. 24.
    Laiyemo AO, Murphy G, Albert PS, Sansbury LB, Wang Z, Cross AJ, et al. Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med. 2008;148:419–26.CrossRefGoogle Scholar
  25. 25.
    Martinez ME, Sampliner R, Marshall JR, et al. Adenoma characteristics as risk factors for recurrence of advanced adenomas. Gastroenterology. 2001;120:1077–83.CrossRefGoogle Scholar
  26. 26.
    Chung SJ, Kim YS, Yang SY, Song JH, Kim D, Park MJ, 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;60:1537–43.CrossRefGoogle Scholar
  27. 27.
    Pinsky PF, Schoen RE, Weissfeld JL, Church T, Yokochi LA, Doria–Rose VP, et al. The yield of surveillance colonoscopy by adenoma history and time to examination. Clin Gastroenterol Hepatol. 2009;7:86–92.CrossRefGoogle Scholar
  28. 28.
    Dube C, Yakubu M, McCurdy BR, et al. Risk of advanced adenoma, colorectal cancer, and colorectal cancer mortality in people with low-risk adenomas at baseline colonoscopy: a systematic review and meta-analysis. Am J Gastroenterol. 2017;112:1790–801.CrossRefGoogle Scholar
  29. 29.
    Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006;130:1872–85.CrossRefGoogle Scholar
  30. 30.
    Anderson JC, Baron JA, Ahnen DJ, Barry EL, Bostick RM, Burke CA, et al. Factors associated with shorter colonoscopy surveillance intervals for patients with low-risk colorectal adenomas and effects on outcome. Gastroenterology. 2017;152:1933–1943.e5.CrossRefGoogle Scholar
  31. 31.
    Leufkens AM, van Oijen MG, Vleggaar FP, Siersema PD. Factors influencing the miss rate of polyps in a back-to-back colonoscopy study. Endoscopy. 2012;44:470–5.CrossRefGoogle Scholar
  32. 32.
    Lee J, Park SW, Kim YS, Lee KJ, Sung H, Song PH, et al. Risk factors of missed colorectal lesions after colonoscopy. Medicine (Baltimore). 2017;96:e7468.CrossRefGoogle Scholar
  33. 33.
    Rex DK, Cutler CS, Lemmel GT, Rahmani EY, Clark DW, Helper DJ, et al. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112:24–8.CrossRefGoogle Scholar
  34. 34.
    Bensen S, Mott LA, Dain B, Rothstein R, Baron J, for the Polyp Prevention Study Group. The colonoscopic miss rate and true one-year recurrence of colorectal neoplastic polyps. Polyp Prevention Study Group. Am J Gastroenterol. 1999;94:194–9.CrossRefGoogle Scholar
  35. 35.
    Moon CM, Jung SA, Eun CS, Park JJ, Seo GS, Cha JM, et al. The effect of small or diminutive adenomas at baseline colonoscopy on the risk of developing metachronous advanced colorectal neoplasia: KASID multicenter study. Dig Liver Dis. 2018;50:847–52.CrossRefGoogle Scholar
  36. 36.
    Kim JY, Kim TJ, Baek S-Y, Ahn S, Kim ER, Hong SN, et al. Risk of metachronous advanced neoplasia in patients with multiple diminutive adenomas. Am J Gastroenterol. 2018;113:1855–61.CrossRefGoogle Scholar
  37. 37.
    Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–803.CrossRefGoogle Scholar
  38. 38.
    Pabby A, Schoen RE, Weissfeld JL, Burt R, Kikendall JW, Lance P, et al. Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. Gastrointest Endosc. 2005;61:385–91.CrossRefGoogle Scholar
  39. 39.
    Rex DK, Bond JH, Winawer S, Levin TR, Burt RW, Johnson DA, et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2002;97:1296–308.CrossRefGoogle Scholar
  40. 40.
    Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2006;63:S16–28.CrossRefGoogle Scholar
  41. 41.
    Anderson JC, Butterly LF, Robinson CM, Goodrich M, Weiss JE. Impact of fair bowel preparation quality on adenoma and serrated polyp detection: data from the New Hampshire colonoscopy registry by using a standardized preparation-quality rating. Gastrointest Endosc. 2014;80:463–70.CrossRefGoogle Scholar
  42. 42.
    Butterly L, Robinson CM, Anderson JC, Weiss JE, Goodrich M, Onega TL, et al. Serrated and adenomatous polyp detection increases with longer withdrawal time: results from the New Hampshire Colonoscopy Registry. Am J Gastroenterol. 2014;109:417–26.CrossRefGoogle Scholar
  43. 43.
    Butterly LF, Nadel MR, Anderson JC, Robinson CM, Weiss JE, Lieberman D, Shapiro JA. Impact of colonoscopy bowel preparation quality on follow-up interval recommendations for average-risk patients with normal screening colonoscopies: data from the New Hampshire Colonoscopy Registry. J Clin Gastroenterol 2018.  https://doi.org/10.1097/MCG.0000000000001115.
  44. 44.
    Corley DA, Jensen CD, Marks AR, Zhao WK, Lee JK, Doubeni CA, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:1298–306.CrossRefGoogle Scholar
  45. 45.
    Kaminski MF, Wieszczy P, Rupinski M, Wojciechowska U, Didkowska J, Kraszewska E, et al. Increased rate of adenoma detection associates with reduced risk of colorectal cancer and death. Gastroenterology. 2017;153:98–105.CrossRefGoogle Scholar
  46. 46.
    Lee TJ, Rees CJ, Blanks RG, Moss SM, Nickerson C, Wright KC, et al. Colonoscopic factors associated with adenoma detection in a national colorectal cancer screening program. Endoscopy. 2014;46:203–11.CrossRefGoogle Scholar
  47. 47.
    Atkin W, Wooldrage K, Brenner A, Martin J, Shah U, Perera S, et al. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. The Lancet Oncol. 2017;18:823–34.CrossRefGoogle Scholar
  48. 48.
    Anderson JC, Butterly LF, Weiss JE, Robinson CM. Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry. Gastrointest Endosc. 2017;85:1188–94.CrossRefGoogle Scholar
  49. 49.
    Holme O, Bretthauer M, Eide TJ, et al. Long-term risk of colorectal cancer in individuals with serrated polyps. Gut. 2015;64(6):929–36.CrossRefGoogle Scholar
  50. 50.
    • Anderson JC, Butterly LF, Robinson CM, et al. Risk of metachronous high-risk adenomas and large serrated polyps in individuals with serrated polyps on index colonoscopy: data from the New Hampshire Colonoscopy Registry. Gastroenterology. 2018;154:117–127 e2 This analysis of data from the New Hampshire Colonoscopy Registry showed that the presence of index serrated polyps, especially sessile serrated polyps (SSP), can increase the risk for metachronous high-risk conventional adenomas (HRA), even greater than that for those with HRA alone. This paper also presented data that showed that large (> 1 cm) serrated polyps or SSPs predict metachronous large SPs but not HRA. CrossRefGoogle Scholar
  51. 51.
    • Anderson JC, Morris CB, Robertson DJ, Barry ELR, Figueiredo JC, Cruz-Correa M, et al. Can the sum of adenoma diameters (adenoma bulk) on index examination predict risk of metachronous advanced neoplasia? J Clin Gastroenterol. 2018;52:628–34 This retrospective analysis of data from a chemoprevention trial demonstrated that a new risk stratification approach to surveillance, which involved adding adenoma size, performed as well as the conventional paradigm. Furthermore, this model did not require information about histology such as villous elements or high-grade dysplasia, which can be subject to variation in interpretation.Google Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Rishabh Sachdev
    • 1
  • Rahul Sao
    • 1
  • John W. Birk
    • 1
  • Joseph C. Anderson
    • 1
    • 2
    Email author
  • Joel Levine
    • 1
    • 3
  1. 1.Department of Medicine in the Division of Gastroenterology and HepatologyUniversity of Connecticut Health CenterFarmingtonUSA
  2. 2.Department of MedicineDepartment of Veterans Affairs Medical CenterWhite River JunctionUSA
  3. 3.Colon Cancer Prevention Program, Neag Comprehensive Cancer CenterUniversity of Connecticut Health CenterFarmingtonUSA

Personalised recommendations