Follow-up surveillance within 5 years may detect post-colonoscopy CRC
Click Here to Manage Email Alerts
CHARLOTTE, N.C. — Recommended surveillance interval was the most important modifiable risk factor for post-colonoscopy colorectal cancer at 3 years, according to research presented at the ACG Annual Scientific Meeting.
“[Post-colonoscopy colorectal cancers (PCCRCs)] are colorectal cancers diagnosed after a colonoscopy in which no colorectal cancer is found. They constitute 5% to 6% of all colorectal cancers and are a true measure of colonoscopy quality as reflected by adenoma detection rate,” Thomas F. Imperiale, MD, distinguished professor and Lawrence Lumeng Professor of Gastroenterology and Hepatology at Indiana University School of Medicine, said. “Knowing risk factors for PCCRCs other than ADR is important for ensuring high-quality colonoscopy at the levels of patient, provider and system.”
To identify risk factors for PCCRC incidence at 3 years, Imperiale and colleagues evaluated 29,877 veterans, aged 50 to 85 years, with newly diagnosed CRC from January 2003 to December 2013, of whom 6% were classified as PCCRRC. Researchers defined those whose colonoscopy occurred less than 6 months before diagnosis with no other colonoscopy within the previous 36 months as having detected CRC, while those whose colonoscopy occurred 6 to 36 months before diagnosis were PCCRC-3y.
Researchers conducted two nested case-control studies (CCS) based on whether patients underwent polypectomy of neoplastic polyps during index colonoscopy and compared PCCRC cases with detected CRC controls. In total, there were 402 cases with 804 matched controls without polypectomy and 404 cases with 808 matched controls with polypectomy.
According to analysis, Charlson score (OR = 1.1; 95% CI, 1-1.21), BMI greater than 30 kg/m2 (OR = 1.66; 95% CI, 1.16-2.39) and a recommended surveillance interval of less than 5 years (OR = 4.67; 95% CI, 3.3-6.66) or missing (OR = 3; 95% CI, 2.17-4.14) were factors that independently associated with PCCRC in the no polypectomy group. Protective factors included good or excellent prep (OR = 0.64; 95% CI, 0.46-0.78).
Among patients in the polypectomy CCS, factors that associated with PCCRC were non-veteran administration colonoscopies (OR = 2.97; 95% CI, 1.11-8.21), non-GI endoscopist (OR = 1.64; 95% CI, 1.16-2.33), advanced adenoma (OR = 2.02; 95% CI, 1.54-2.65), two or more proximal polyps (OR = 1.43; 95% CI, 1.09-1.87) and a recommended follow-up of less than 1 year (OR = 3.38; 95% CI, 2.4-4.8).
“Several factors are associated with PCCRC in 5 years, some of which are modifiable, the most important of which is the recommended colonoscopy follow-up interval either for re-screening or surveillance,” Imperiale concluded. “These factors may be useful for tailoring the interval and as targets for quality improvement.”
Collapse
Imperiale TF, et al. Abstract S245: Risk factors for 5-year post-colonoscopy colorectal cancers
(PCCRCs). Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid meeting).
Click Here to Manage Email Alerts