Current guidelines for follow-up of high-risk adenomas may not apply to all patients

A recent study suggests that the 2012 Multi-Society Task Force recommendation for the surveillance of high-risk adenoma (HRA) may not be applicable to all patients.

Patients who were followed at a median of 4.5 years did not appear to have more HRA than those who were followed at 3 years (25.2 percent vs 21.0 percent; p=0.062). Baseline characteristics were comparable between the two groups.

The following factors were predictors of future HRAs: older age, male gender, having a history of polyps and piecemeal resection of an HRA. The removal of ≥3 adenomas in 2008 as well as a combination of multiple, large and advanced polyps were associated with a higher risk of future HRAs.

“We showed that a combination of patient demographics, procedural factors and pathology best determines the surveillance colonoscopy interval,” the authors said.

This study sought to determine whether variation from the 3-year follow-up interval correlated with subsequent HRA. A total of 495 patients who had their HRA removed during a 2008 colonoscopy were analysed in 2016. The frequency of finding another HRA at follow-up intervals were then compared.

The current guidelines were used as the referent group. Logistical regression was performed to determine whether any patient characteristics, procedural factors or HRA type predicted the development of HRAs on follow-up colonoscopy.

HRAs included an adenoma measuring ≥10 mm, ≥3 adenomas found during a single procedure, and an adenoma with high-grade dysplasia or villous architecture. The current Multi-Society Task Force guideline for timing of surveillance colonoscopy after removal of an HRA is 3 years.