Long term outcomes of colon polyps with high grade dysplasia following endoscopic resection

Background The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. Methods 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. Results Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3–12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06–9.04 95% CI), 3.47 (1.67–7.22 95% CI), 2.55 (1.11–5.89 95% CI), 2.46 (1.16–5.22 95% CI), 2.89 (1.44–5.78 95% CI), respectively. Multivariate analysis revealed gender (male) [P = 0.010; OR 3.09(1.32–7.25 95% CI)] and adenoma count ≥ 3 [P = 0.002; OR 3.08(1.52–6.24 95% CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. Conclusion Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.

Long Term Outcomes of Colon Polyps with High Grade Dysplasia Following Endoscopic Resection

Background The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. Methods 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. Results Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3-12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06-9.04 95%CI), 3.47 (1.67-7.22 95%CI), 2.55 (1.11-5.89 95%CI), 2.46 (1.16-5.22 95%CI), 2.89 (1.44-5.78 95%CI), respectively. Multivariate analysis revealed gender (male) [P=0.010; OR 3.09(1.32-7.25 95% CI)] and adenoma count ≥ 3 [P=0.002; OR 3.08(1.52-6.24 95%CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. Conclusion Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.

To screen or not to screen: Colonoscopy, a story of successful population-based screening.

508 Background: Screening for neoplasia of the breast and prostate has come under increasing scrutiny. However, little is understood regarding the temporal impact of screening on incidence and mortality for colorectal cancer (CRC). Methods: We selected states that had both CRC screening prevalence estimates from The Behavioral Risk Factor Surveillance System (BRFSS) and cancer registry data from The Surveillance, Epidemiology, and End Results (SEER) data from 1988-2012. We used SEER*Stat to compute age-adjusted incidence and mortality rates by state.Correlation coefficients were computed for change in screening. Results: The states California, Connecticut, Georgia, Hawaii, Iowa, New Mexico, and Utah were included. Each statehad unique population and tumor characteristics for age, gender, race, socioeconomic status, stage of presentation,and location of the primary, < 0.0001. Over the study period for ages 50 +, there was an increase in screening endoscopy (41 to 64%, R2 = 0.77, p < 0.0001) and a slight decrease in fecal occult blood testing (25 to 23%, R2 = 0.28, p < 0.0001). Similar trends were noted by state. There was an inverse relationship between increased screening endoscopy and incidence of CRC (60.03 to 34.68/100.000, R2 = 0.95 and p = < 0.0001); this was pronounced for early disease (45.4 to 25.7/100,000, p = < 0.0001) and minimal for late stage disease (10.5 to 7.2/100,000, p = 0.014). There was comparable trend in mortality (23.27 to 13.47 per 100.000). When evaluating states individually, the association between increasing endoscopic screening and the trends in incidence and mortality were robust (R2 0.75 – 0.92 and R2 0.65-0.95, respectively p < 0.0001). However, when states were analyzed collectively the association of screening with decreases in incidence and mortality was weaker (R2 = 0.27, p = 0.005 and R2 = 0.65, p = 0.06, respectively). Conclusions: Increased screening for CRC coincides with a decrease in incidence and mortality, disproportionality decreasing early stage cancer. This correlation is very strong within states but diminished between states, suggesting factors in addition to creening are influencing the epidemiology of CRC.