María Elena Martínez, PhD; Dennis Ahnen, MD; E. Robert Greenberg, MD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1274.
Martínez ME, Ahnen D, Greenberg ER. One-Year Risk for Advanced Colorectal Neoplasia. Ann Intern Med. 2013;158:639. doi: 10.7326/0003-4819-158-8-201304160-00019
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Published: Ann Intern Med. 2013;158(8):639.
We thank Dr. Rex for his thoughtful discussion of the implications of our report for the U.S. colonoscopy surveillance guidelines. He particularly emphasizes the importance of improving endoscopy quality, a point that we acknowledged in our study. Indeed, 73% (200 of 273) of all advanced neoplasms and 69% (18 of 26) of high-grade dysplasias or cases of cancer that were detected at the 1-year colonoscopy in our sample occurred among patients who would not be categorized as high-risk by the U.K. guidelines.
Focusing on colonoscopy performance clearly deserves a high priority. However, examination is not likely to be perfect if multiple adenomas are detected (as Dr. Rex has noted), and current surveillance intervals are based on estimates of the rate of advanced neoplasms over time from studies similar to those included in our study.
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