High-quality index colonoscopy protects against interval CRC, supports 10-year follow-up
CHARLOTTE, N.C. — High-quality index colonoscopy decreased the risk for advanced long-term outcomes among New Hampshire residents with no adenomas or significant serrated polyps, according to research at the ACG Annual Scientific Meeting.
“In 2020, under the leadership of Samir Gupta, we updated guidelines for post-polypectomy colonoscopy. While the guidelines changed a lot, having a normal exam — in other words, no adenomas or serrated polyps — did not change. We recommended a 10-year follow-up in those individuals,” Joseph C. Anderson, MD, a physician at Dartmouth University, said. “This is predicated on a high-quality exam.”
Using data from the New Hampshire Colonoscopy Registry (NHCR), Anderson and colleagues investigated the impact of index colonoscopy on the long-term risk for advanced outcomes among 14,011 individuals (mean age, 56.3 years; 41.2% men) with low-risk findings. They compared high-quality exams — defined as a “complete exam with adequate bowel preparation performed by an endoscopist with an adenoma detection rate of 25 or higher” — with low-quality exams. Long-term follow-up exams (10 years) were available for 2,283 individuals.
According to study results, the absolute risk for advanced outcomes after 10 years was lower among individuals who underwent high-quality index exams compared with low-quality index exams (4% [37/918] vs. 6.7% [91/1,365]). The adjusted risk also was lower in the high-quality exam group (OR = 0.59; 95% CI, 0.39-0.88). The low-quality group had a “statistically significant” increase in the absolute risk at 10 years or longer.
“High-quality index colonoscopy provides better protection from interval lesions than low-quality exams in individuals with no polyps detected at that index exam. These data support the importance of high-quality index exams in the prevention of interval colorectal cancer and support the 10-year interval for normal exams,” Anderson concluded. “Endoscopists should focus on the quality of their exams by employing adequate withdrawal time to ensure optimal adenoma detection and ensuring optimal bowel preparation in their practice.”
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Anderson JC, et al. Abstract S587: High-quality index colonoscopies decrease the risk for advanced neoplasia at 10-year follow-up colonoscopy in low-risk patients with no index adenomas or serrated polyps. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meeting).
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