Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy.
BACKGROUND
Three-year colonoscopic surveillance after initial polypectomy may not be required for all patients. Those with multiple baseline polyps and large adenomas, implicated as predictors of colon cancer, merit close observation. Conversely, patients with single small adenomas may be subjected to early endoscopic surveillance unnecessarily.


METHODS
From our Adenoma Registry we evaluated patient and adenoma characteristics in 697 patients. All had an adenoma recurrence within 3 years of a positive baseline colonoscopy. Potential risk factors studied were age, gender, number of adenomas, size of largest adenoma and histology. We defined a significant outcome as size of 1 cm or greater, tubulovillous or villous histology, high-grade dysplasia, carcinoma in situ, invasive cancer, or 4 or more adenomas.


RESULTS
Having 3 or more adenomas on initial colonoscopy with at least 1 measuring 1 cm or larger greatly increased the chance of a significant finding on the first surveillance colonoscopy. Conversely, patients with 1 or 2 adenomas all measuring less than 1 cm were at extremely low risk of an important outcome within 3 years.


CONCLUSIONS
Patients with 1 or 2 adenomas all measuring less than 1 cm are an identified low risk group and their first surveillance examination may be delayed beyond the standard 3 years.
Noshirwani
K C
KC
Cleveland Clinic Foundation, Cleveland, Ohio, USA.
van Stolk
R U
RU
Rybicki
L A
LA
Beck
G J
GJ
D018256:Adenomatous Polyps / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D011237:Predictive Value of Tests; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity