title: A risk index for advanced neoplasia on the second surveillance colonoscopy in patients with previous adenomatous polyps.
abstract: BACKGROUND
  Predicting the risk of advanced colorectal neoplasia on the second surveillance colonoscopy could help tailor surveillance.
  
  
  OBJECTIVE
  To derive and validate a risk index for advanced neoplasia on the second surveillance colonoscopy.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Single-specialty practice; Veterans Affairs Medical Center.
  
  
  METHODS
  A total of 965 patients with baseline adenomatous polyps, 2 surveillance colonoscopies, and no reported family history of colorectal cancer; validation cohort of 372.
  
  
  METHODS
  Multivariable logistic regression including demographics and previous colonoscopy results; derivation and validation of a risk index.
  
  
  METHODS
  Advanced adenoma (≥1 cm in size, villous histology, or high-grade dysplasia) on the second surveillance colonoscopy.
  
  
  RESULTS
  Mean age was 57.8 ± 9.8 years, 62% were men, and 36% had an advanced adenoma on the index colonoscopy. Associated with advanced adenoma on the second surveillance colonoscopy were age at index colonoscopy (scored 0 for younger than 55 years of age, 1 for 55-59 years of age, 2 for 60-64 years of age, and 3 for older than 65 years of age) and previous findings (non-neoplastic, nonadvanced, advanced [scored 0, 1, and 2, respectively]) on index colonoscopy and the first surveillance colonoscopy, with scores ranging from 1 to 7. Risks of advanced adenoma on the second surveillance colonoscopy with scores of 5 or less and more than 5 were 4.8% (95% confidence interval, 3.5%-6.4%) and 14.9% (95% confidence interval, 7.4%-25.7%), respectively, comprising 93% and 7%, respectively, of the cohort. Corresponding results in the validation cohort were 5.6% and 19.2%, respectively, comprising 86.1% and 13.9%, respectively, of the cohort.
  
  
  CONCLUSIONS
  Retrospective study with potential for selection bias.
  
  
  CONCLUSIONS
  This index stratifies the risk of advanced adenoma on the second surveillance colonoscopy. If validated independently, it may be useful for tailoring surveillance.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Indianapolis University School of Medicine, Indianapolis, Indiana, USA; Regenstrief Institute, Inc, Indianapolis, Indiana, USA; Center of Excellence for Implementation of Evidence-based Practice, Roudebush VA Medical Center, Indianapolis, Indiana, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Indianapolis University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Juluri
authors.affiliation: Department of Chemical Engineering, Louisiana Tech University, Ruston, Louisiana, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sherer
authors.affiliation: Indianapolis Gastroenterology Research Foundation, Indianapolis University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Glowinski
authors.affiliation: Department of Biostatistics, Indianapolis University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.affiliation: Indianapolis Gastroenterology Research Foundation, Indianapolis University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Morelli
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D018256:Adenomatous Polyps / Q000473:pathology*; D000367:Age Factors; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D013223:Statistics as Topic