Lack of confidence in postpolypectomy surveillance guidelines may be a factor in the observed low adherence rates among providers.
Dr Adeyinka Laiyemo and colleagues assessed the 2006 postpolypectomy colonoscopy surveillance guidelines.
These guidelines recommend 3-year follow-up colonoscopy for individuals with high-risk adenomas.
In addition, the guidelines recommend 5- to 10-year follow-up for patients with 2 or fewer nonadvanced adenomas, who are considered to be at low risk.
The research team analyzed prospective data from the Polyp Prevention Trial.
|60% had no recurrence within 4 years of follow-up|
|Annals of Internal Medicine|
The team evaluated 1905 patients who had colorectal adenomas removed at baseline screening or diagnostic colonoscopy and completed the trial.
Baseline adenoma characteristics, risk-stratified according to definitions used in the guidelines, were examined as predictors for advanced adenoma recurrence.
The research team noted that 7% of patients had advanced, and 33% had nonadvanced adenoma recurrence.
The team noted that 60% had no recurrence within 4 years of follow-up.
The probability of advanced adenoma recurrence was 0.09 among patients with high-risk adenomas at baseline.
The researchers observed that the probability of advanced adenoma recurrence was 0.05 among those with low-risk adenomas at baseline.
The relative risk for advanced adenoma recurrence for patients with high-risk vs those with low-risk adenomas at baseline was 1.68 when advanced adenoma recurrence was compared with no advanced adenoma recurrence.
The relative risk for advanced adenoma recurrence for patients with high-risk vs low-risk adenomas at baseline was 1.76 when advanced adenoma recurrence was compared with no adenoma recurrence.
The c-statistics for these 2 comparisons were 0.68 and 0.72, respectively.
Participants were self-selected and had restrictions on the degree of obesity.
Dr Laiyemo's team concluded, "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."