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Using the Results of a Baseline and a Surveillance Colonoscopy to Predict Recurrent Adenomas With High-Risk Characteristics

Douglas J. Robertson, MD, MPH; Carol A. Burke, MD; H. Gilbert Welch, MD, MPH; Robert W. Haile, DrPh; Robert S. Sandler, MD, MPH; E. Robert Greenberg, MD; Dennis J. Ahnen, MD; Robert S. Bresalier, MD; Richard I. Rothstein, MD; Bernard Cole, PhD; Leila A. Mott, MS; and John A. Baron, MD
[+] Article and Author Information

From the Veterans Affairs Outcomes Group, White River Junction, and University of Vermont, Burlington, Vermont; Dartmouth Hitchcock Medical Center, Lebanon, and Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire; Cleveland Clinic Foundation, Cleveland, Ohio; University of Southern California Keck School of Medicine, Los Angeles, California; University of North Carolina, Chapel Hill, North Carolina; Fred Hutchinson Cancer Research Center, Seattle, Washington; Denver Department of Veterans Affairs Medical Center and University of Colorado, Denver School of Medicine, Denver, Colorado; and University of Texas M.D. Anderson Cancer Center, Houston, Texas.


This study was presented in part as an oral presentation at Digestive Disease Week, Los Angeles, California, 21 May 2006. Dr. Robertson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Grant Support: Dr. Robertson's work is supported by a Veterans Affairs Health Services Research & Development Career Development Award. The parent study was supported by grant R01 CA 59005 from the National Institutes of Health.

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement:Study protocol: The protocol for the Aspirin/Folate trial is available from Dr. Robertson (e-mail, douglas.robertson@va.gov). Statistical code: Available from Dr. Robertson (e-mail, douglas.robertson@va.gov). Data set: The Polyp Prevention Study Group welcomes financially supported collaboration using the data from our chemoprevention trials. Please contact the group through Dr. Robertson (e-mail, douglas.robertson@va.gov).

Requests for Single Reprints: Douglas J. Robertson, MD, MPH, Veterans Affairs Medical Center, 215 North Main Street, Section of Gastroenterology (111E), White River Junction, VT 05009; e-mail, douglas.robertson@va.gov.

Current Author Addresses: Dr. Robertson: Veterans Affairs Medical Center, 215 North Main Street, Section of Gastroenterology (111E), White River Junction, VT 05009.

Dr. Burke: Department of Gastroenterology and Hepatology, Desk A30, 9500 Euclid Avenue, Cleveland, OH 44195.

Dr. Welch: Veterans Affairs Medical Center, 215 North Main Street, Veterans Affairs Outcomes Group (111B), White River Junction, VT 05009.

Dr. Haile: Department of Preventive Medicine, Genetic Epidemiology Program, Harlyne Norris Research Tower, 1450 Biggy Street, Room 1506, Mail Code LG591 MC9603, Los Angeles, CA 90033.

Dr. Sandler: Division of Gastroenterology and Hepatology, CB# 7555, 4157 Bioinformatics Building, University of North Carolina, Chapel Hill, NC 27599-7555.

Dr. Greenberg: Cancer Research and Biostatistics, 1780 Minor Avenue, Suite 1900, Seattle, WA 98101-1468.

Dr. Ahnen: Denver Veterans Affairs Medical Center 111E, 1055 Clermont Street, Denver, CO 80220.

Dr. Bresalier: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Unit 1466, 1515 Holcombe Boulevard, Houston, TX 77030-4009.

Dr. Rothstein: Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Section of Gastroenterology, Lebanon, NH 03756-1000.

Dr. Cole: Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT 05405.

Ms. Mott and Dr. Baron: Section of Biostatistics & Epidemiology, Dartmouth Medical School, Evergreen Center, 46 Centerra Parkway, Suite 300, Room 339, Lebanon, NH 03766.

Author Contributions: Conception and design: D.J. Robertson, C.A. Burke, H.G. Welch, R.W. Haile, E.R. Greenberg, R.S. Bresalier, J.A. Baron.

Analysis and interpretation of the data: D.J. Robertson, C.A. Burke, H.G. Welch, R.W. Haile, R.S. Sandler, E.R. Greenberg, R.S. Bresalier, J.A. Baron, L. Mott.

Drafting of the article: D.J. Robertson, R.W. Haile, E.R. Greenberg, R.S Bresalier, L.A. Mott.

Critical revision for important intellectual content: D.J. Robertson, C.A. Burke, H.G. Welch, R.W. Haile, R.S. Sandler, E.R. Greenberg, R.S. Bresalier, R.I. Rothstein, J.A. Baron.

Final approval of the article: D.J. Robertson, C.A. Burke, H.G. Welch, R.W. Haile, R.S. Sandler, E.R. Greenberg, R.S. Bresalier, R.I. Rothstein, L.A. Mott, J.A. Baron.

Provision of study materials or patients: C.A. Burke, R.W. Haile, R.S. Sandler, E.R. Greenberg, R.S. Bresalier.

Statistical expertise: H.G. Welch, E.R. Greenberg.

Obtaining of funding: D.J. Robertson, R.S. Bresalier, J.A. Baron.

Administrative, technical, or logistic support: D.J. Robertson, H.G. Welch, E.R. Greenberg, R.S. Bresalier, R.I. Rothstein, J.A. Baron.

Collection and assembly of data: C.A. Burke, R.W. Haile, R.S. Sandler, E.R. Greenberg, R.S. Bresalier, R.I. Rothstein, J.A. Baron.


Ann Intern Med. 2009;151(2):103-109. doi:10.7326/0003-4819-151-2-200907210-00007
Text Size: A A A

Background: Suggested intervals for postpolypectomy surveillance colonoscopy are currently based on the adenoma findings from the most recent examination.

Objective: To determine the risk for clinically significant adenoma recurrence on the basis of the results of 2 previous colonoscopies.

Design: Prospective cohort study.

Setting: Academic and private centers in North America.

Patients: Participants in an adenoma chemoprevention trial in which all participants had 1 or more adenoma found on complete colonoscopy at entry. For this analysis, only participants whose qualifying adenoma was their first were included. All participants then underwent second and third study colonoscopies at roughly 3-year intervals.

Measurements: Proportion of patients with high-risk findings at the third study colonoscopy—either at least 1 advanced (≥1 cm or advanced histology) adenoma or multiple (≥3) adenomas.

Results: Fifty-eight of 564 participants (10.3%) had high-risk findings at the third study examination. If the second examination showed high-risk findings, then results from the first examination added no significant information about the probability of high-risk findings on the third examination (18.2% for high-risk findings on the first examination vs. 20.0% for low-risk findings on the first examination; P = 0.78). If the second examination showed no adenomas, then the results from the first examination added significant information about the probability of high-risk findings on the third examination (12.3% if the first examination had high-risk findings vs. 4.9% if the first examination had low-risk findings; P = 0.015).

Limitation: This observational study cannot specifically examine adenoma recurrence risk at intervals suggested for patients with low-risk adenomas (for example, 5 years vs. 10 years).

Conclusion: Information from 2 previous examinations may help identify low-risk populations that benefit little from intense surveillance. Surveillance guidelines might be tailored in selected patients to use information from 2 previous examinations, not just the most recent one.

Primary Funding Source: National Institutes of Health.

Figures

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Figure 1.
Composition of analytic cohort relative to participants randomly assigned into the parent Aspirin/ Folate trial.
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Figure 2.
Absolute risk for advanced or multiple adenoma detection on the third colonoscopy.
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