‘Small difference’ in colorectal neoplasia recurrence at 5 vs. 10 years after polypectomy
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Key takeaways:
- Rates of advanced colorectal neoplasia recurrence were 1.5% at 5 years and 2.42% at 7 to 10 years.
- Older age, male sex and absence of diabetes or cardiovascular disease were significantly linked with recurrence.
Study findings support performing surveillance colonoscopy 7 to 10 years after detection and polypectomy of baseline non-advanced adenoma rather than at 5 years, researchers wrote in the Journal of Gastroenterology and Hepatology.
“Post-polypectomy surveillance is a crucial component of screening practice,” Martin C.S. Wong, of the Chinese University of Hong Kong, and colleagues wrote. “Nevertheless, the preventive effect of these post-polypectomy surveillance procedures is smaller than that of screening colonoscopy due to their lower yield of adenomatous polyps. It is therefore important to increase the efficiency of these surveillance colonoscopies.”
They continued: “Determination of post-polypectomy surveillance intervals will require careful consideration of existing scientific evidence to promote best practice.”
In a territory-wide, retrospective cohort study, Wong and colleagues used the Hospital Authority Data Collaboration Lab of Hong Kong to identify 109,768 individuals (mean age, 67.35 years; 60.9% men) who underwent polypectomy for non-advanced adenoma (NAA) at a baseline colonoscopy between 2008 and 2018.
The primary outcome was recurrence of advanced colorectal neoplasia (ACN) at surveillance colonoscopy performed 5 years vs. 7 to 10 years after baseline.
Researchers noted 30,626 and 6,848 patients underwent follow-up colonoscopy at 4 to 6 years and 7 to 10 years, respectively. The crude recurrence rates of ACN at those intervals were 1.5% and 2.42% (crude OR = 1.629; 95% CI, 1.362-1.949).
Univariate analysis demonstrated lower likelihood of ACN recurrence with more recent first colonoscopy (cOR = 0.901; 95% CI, 0.897-0.904), while older age (56-70 years; cOR = 1.265-2.036), male sex (cOR = 1.49; 95% CI, 1.428-1.554), absence of diabetes (cOR = 0.722; 95% CI, 0.692-0.754) or cardiovascular disease (cOR = 0.824; 95% CI, 0.79-0.86) were significantly linked with recurrence.
Further, results from the binary logistic regression model showed those who underwent surveillance at 7 to 10 years had a statistically higher recurrence rate of ACN compared with those who underwent surveillance at 4 to 6 years (adjusted OR = 1.544; 95% CI, 1.266-1.877). However, researchers noted the strength of OR was considered “weak.”
“There is a small difference in recurrence of ACN between individuals who received colonoscopy workup at 5 years vs. 7 to 10 years,” Wong and colleagues concluded. “These findings support a 7- to 10-year surveillance period after baseline NAA was polypectomized.”
They continued: “Our findings could facilitate formulation of future guidelines and consensus statements on the optimal surveillance interval following the diagnosis of newly diagnosed NAA in people at risk for ACN. We recommend future studies be examined in other ethnic groups.”
Perspective
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Adrienna Jirik, MD
This study touched upon other risk factors for metachronous neoplasia, including age and lifestyle factors. An interesting observation was an increased risk in those without diabetes and cardiovascular disease, as other systematic reviews and meta-analyses have suggested an increased risk in those patients. Other potentially modifiable risk factors that have been identified include a sedentary lifestyle, use of tobacco products and excess consumption of red meat and alcohol.
However, it is important to note that data regarding these risk factors have been largely observational, with no definitive causal relationship yet established. More studies are needed to determine this and their potential role in advising patients on ideal timing of their first screening colonoscopy and proper subsequent screening and surveillance colonoscopies.
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