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Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years.

Abstract：

BACKGROUND:Lack of confidence in postpolypectomy surveillance guidelines may be a factor in the observed low adherence rates among providers. OBJECTIVE:To assess the 2006 postpolypectomy colonoscopy surveillance guidelines, which recommend 3-year follow-up colonoscopy for individuals with high-risk adenomas (defined as > or =3 adenomas or any advanced adenomas) and 5- to 10-year follow-up for patients with 2 or fewer nonadvanced adenomas, who are considered to be at low risk. DESIGN:Analysis of prospective data from the Polyp Prevention Trial. SETTING:United States. PARTICIPANTS:1905 patients who had colorectal adenomas removed at baseline screening or diagnostic colonoscopy and completed the trial. MEASUREMENTS:Baseline adenoma characteristics, risk-stratified according to definitions used in the guidelines, were examined as predictors for advanced adenoma recurrence. RESULTS:125 patients (6.6%) had advanced and 629 (33.0%) had nonadvanced adenoma recurrence; 1151 (60.4%) had no recurrence within 4 years of follow-up. The probability of advanced adenoma recurrence was 0.09 (95% CI, 0.07 to 0.11) among patients with high-risk adenomas at baseline and 0.05 (CI, 0.04 to 0.06) among those with low-risk adenomas at baseline. The relative risk for advanced adenoma recurrence for patients with high-risk adenomas versus those with low-risk adenomas at baseline was 1.68 (CI, 1.19 to 2.38) when advanced adenoma recurrence was compared with no advanced adenoma recurrence and 1.76 (CI, 1.26 to 2.46) when advanced adenoma recurrence was compared with no adenoma recurrence. The c-statistics for these 2 comparisons were 0.68 and 0.72, respectively. LIMITATION:Participants were self-selected and had restrictions on the degree of obesity. CONCLUSION:Although the risk for recurrence of advanced adenoma within 4 years is greater for patients with high-risk adenomas at baseline than for those with low-risk adenomas, the discrimination of this risk stratification scheme is relatively low.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Laiyemo AO,Murphy G,Albert PS,Sansbury LB,Wang Z,Cross AJ,Marcus PM,Caan B,Marshall JR,Lance P,Paskett ED,Weissfeld J,Slattery ML,Burt R,Iber F,Shike M,Kikendall JW,Lanza E,Schatzkin A

doi

10.7326/0003-4819-148-6-200803180-00004

subject

Has Abstract

pub_date

2008-03-18 00:00:00

pages

419-26

issue

eissn

0003-4819

issn

1539-3704

pii

148/6/419

journal_volume

148

pub_type

杂志文章,多中心研究,随机对照试验

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Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years.