Risk factors of nonadherence to colonoscopy surveillance after polypectomy and its impact on clinical outcomes: a KASID multicenter study.
BACKGROUND
An optimal surveillance program is important to prevent advanced colorectal neoplasm. In this context, we have evaluated the cumulative risk of high-risk adenoma (HRA) or colorectal cancer (CRC) according to surveillance interval time after polypectomy. In addition, we assessed risk factors for late surveillance to determine whether late surveillance can impact the risk of subsequent advanced colorectal neoplasm.


METHODS
This was a multicenter retrospective cohort study involving 3562 subjects who had undergone removal of at least one adenoma at the index colonoscopy and who subsequently underwent a surveillance colonoscopy. The subjects were classified into an early, appropriate or late group depending on the timing of the surveillance colonoscopy, performed using modified U.S.


CONCLUSIONS



RESULTS
With 3% of the study population with LRA and HRA at the index colonoscopy going on to develop HRA or CRC, the estimated surveillance intervals calculated would be 6.3 [95% confidence interval (CI) 5.42-7.10] years and 3.1 (95% CI 2.61-4.45) years, respectively. The predictors of late surveillance were female gender [odd ratio (OR) 1.21; 95% CI 1.04-1.40], having undergone the procedure in small-to-medium-sized cities (OR 1.92; 95% CI 1.36-2.72) and HRA at index colonoscopy (OR 1.37; 95% CI 1.19-1.59). The risk factors for subsequent HRA or CRC were late surveillance (OR 1.34; 95% CI 1.03-1.74), male gender (OR 2.13; 95% CI 1.54-2.95), having undergone the procedure in small-to-medium-sized cities (OR 1.63; 95% CI 1.11-2.40) and HRA at index colonoscopy (OR 2.60; 95% CI 2.04-3.33).


CONCLUSIONS
Women, having undergone the procedure in small-to-medium-sized cities and the presence of an HRA at the index colonoscopy were found to be independent risk factors for late surveillance colonoscopy. Late surveillance is significantly predictive of subsequent HRA or CRC.
Department of Health Promotion Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Chung Hyun
CH
Tae
Department of Internal Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea. mooncm27@ewha.ac.kr.
Chang Mo
CM
Moon
Department of Internal Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
Seong-Eun
SE
Kim
Department of Internal Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
Sung-Ae
SA
Jung
Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea.
Chang Soo
CS
Eun
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Jae Jun
JJ
Park
Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Republic of Korea.
Geom Seog
GS
Seo
Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Jae Myung
JM
Cha
Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
Sung Chul
SC
Park
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jaeyoung
J
Chun
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Hyun Jung
HJ
Lee
Department of Internal Medicine, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
Yunho
Y
Jung
Department of Internal Medicine, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
Jin Oh
JO
Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Young-Eun
YE
Joo
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Dong Il
DI
Park
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002947:Cities; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011159:Population Surveillance; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
Adherence; Colonoscopy; Colorectal cancer