title: Features of adenoma and colonoscopy associated with recurrent colorectal neoplasia based on a large community-based study.
abstract: OBJECTIVE
  We investigated adenoma and colonoscopy characteristics that are associated with recurrent colorectal neoplasia based on data from community-based surveillance practice.
  
  
  METHODS
  We analyzed data of 2990 consecutive patients (55% male; mean age 61 years) newly diagnosed with adenomas from 1988 to 2002 at 10 hospitals throughout The Netherlands. Medical records were reviewed until December 1, 2008. We excluded patients with hereditary colorectal cancer (CRC) syndromes, a history of CRC, inflammatory bowel disease, or without surveillance data. We analyzed associations among adenoma number, size, grade of dysplasia, villous histology, and location with recurrence of advanced adenoma (AA) and nonadvanced adenoma (NAA). We performed a multivariable multinomial logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  During the surveillance period, 203 (7%) patients were diagnosed with AA and 954 (32%) patients with NAA. The remaining 1833 (61%) patients had no adenomas during a median follow-up of 48 months. Factors associated with AA during the surveillance period included baseline number of adenomas (ORs ranging from 1.6 for 2 adenomas; 95% CI: 1.1-2.4 to 3.3 for ≥5 adenomas; 95% CI: 1.7-6.6), adenoma size ≥10 mm (OR = 1.7; 95% CI: 1.2-2.3), villous histology (OR = 2.0; 95% CI: 1.2-3.2), proximal location (OR = 1.6; 95% CI: 1.2-2.3), insufficient bowel preparation (OR = 3.4; 95% CI: 1.6-7.4), and only distal colonoscopy reach (OR = 3.2; 95% CI: 1.2-8.5). Adenoma number had the greatest association with NAA. High-grade dysplasia was not associated with AA or NAA.
  
  
  CONCLUSIONS
  Large size and number, villous histology, proximal location of adenomas, insufficient bowel preparation, and poor colonoscopy reach were associated with detection of AA during surveillance based on data from community-based practice. These characteristics should be used jointly to develop surveillance policies for adenoma patients.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. e.vanheijningen@erasmusmc.nl
authors.forename: Else-Mariëtte B
authors.initials: EM
authors.lastname: van Heijningen
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.forename: Wilco
authors.initials: W
authors.lastname: Lesterhuis
authors.forename: Frank
authors.initials: F
authors.lastname: Ter Borg
authors.forename: Juda
authors.initials: J
authors.lastname: Vecht
authors.forename: Vincent
authors.initials: V
authors.lastname: De Jonge
authors.forename: Pieter
authors.initials: P
authors.lastname: Spoelstra
authors.forename: Leopold
authors.initials: L
authors.lastname: Engels
authors.forename: Clemens J M
authors.initials: CJ
authors.lastname: Bolwerk
authors.forename: Robin
authors.initials: R
authors.lastname: Timmer
authors.forename: Jan H
authors.initials: JH
authors.lastname: Kleibeuker
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Koornstra
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
mesh_terms: D000236:Adenoma / Q000473:pathology*; D018253:Adenoma, Villous / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009378:Neoplasms, Multiple Primary / Q000473:pathology*