Yield of Second Surveillance Colonoscopy to Predict Adenomas with. High - Risk Characteristics

Transcription

1 Yield of Second Surveillance Colonoscopy to Predict Adenomas with High - Risk Characteristics Ido Laish, Ido Blechman, Haya Feingelernt, Fred M Konikoff Gastroenterology and Hepatology Institute, Meir Medical Center

2 Surveillance after adenoma resection Number of adenomas Size Histology (low/high grade dysplasia, tubular/villous adenoma)

3 Surveillance based on findings at baseline : (AGA guidelines) (1) Normal: surveillance at 10y (2) Low-risk adenoma (LRA) = 1-2 small TA s : surveillance at 5y (3) High-risk adenoma (HRA) = polyp > 10mm villous histology (TVA) surveillance at 3y high grade dysplasia 3 small TA s

4 Surveillance intervals after the first follow-up?

5 Surveillance intervals after the first follow-up?

6 Pitfalls Inconsistency in defining outcome (HRA, advanced adenoma) Inconsistency in time intervals Based on data from clinical trials, may not reflect clinical practice Homogenous non-symptomatic population

7 Aim of study Quantify the risk of HRA findings at 2 nd surveillance based on findings from baseline and 1 st surveillance colonoscopies real-life patients (both symptomatic and asymptomatic) Time intervals determined by guidelines and clinical practice

8 Patients and Methods Retrospective cohort study Patients from MMC and affiliated gastroenterology clinics Adults > 30y with 3 colonoscopies (baseline + two surveillance) Pathology reports available for evaluation Interval: at least 1 year, no more than 10y

9 Patients and Methods When more than one polyp was found, the most advanced was recorded for the purpose of categorization

10 Patients and Methods When more than one polyp was found, the most advanced was recorded for the purpose of categorization Based on findings at baseline, population was categorized: HRA, LRA, no adenoma (NA) Advanced adenomas (size, histology) 3 non-advanced adenomas 1-2 non-advanced adenomas

11 Patients and Methods Outcome measure: Rate of HRA / colorectal cancer at 2 nd surveillance in each category

12 Patients and Methods Exclusion criteria: Colorectal cancer (CRC) at baseline/ 1 st surveillance Inflammatory bowel disease Genetic syndromes Poor bowel preparation

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14 Results Baseline HRA LRA NA P-Value characteristics (n=252) (n=158) (n=318) Male 146 (58%) 93 (59%) 137 (43%) <0.001 * Origin - Jews 250 (99%) 158 (100%) 313 (98%) Arabs 2 (1) 0 5 (2) Family history of CRC 70 (28%) 49 (31%) 139 (44%) <0.001 * Adenoma location - Distal only - Proximal only - Both 164 (65%) 40 (16%) 48 (19%) 114 (72%) 27 (17%) 17 (11%)

15 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

16 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

17 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

18 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

19 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

20 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

21 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

22 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

23 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

24 Baseline HRA (n = 252) LRA (n = 158) NA (n = 318) Baseline to 1 st Finding at first surveillance N (%) mean (Years) NA 46 1 st to 2 nd Finding at second surveillance N (%) HRA LRA NA mean (Years) LRA HRA NA LRA HRA NA LRA HRA

25 Results (cont.) Incidence of CRC at 2 nd surviellance: 15 patients (11- invasive, 4- intramucosal) Incidence among baseline groups: HRA - 1.2% (3/252), LRA - 3.2% (5/158), NA- 1.9% (7/318) Incidence among 1 st surveillance groups: HRA - 1.6% (2/128), LRA % (1/134), NA- 2.6% (12/466)

26 Results (cont.) Incidence of CRC at 2 nd surviellance: 15 patients (11- invasive, 4- intramucosal) Incidence among baseline groups: HRA - 1.2% (3/252), LRA - 3.2% (5/158), NA- 1.9% (7/318) Incidence among 1 st surveillance groups: HRA - 1.6% (2/128), LRA % (1/134), NA- 2.6% (12/466)

27 Results (cont.) Incidence of CRC at 2 nd surviellance: 15 patients (11- invasive, 4- intramucosal = IMC) Incidence among baseline groups: HRA - 1.2% (3/252), LRA - 3.2% (5/158), NA- 1.9% (7/318) Incidence among 1 st surveillance groups: HRA - 1.6% (2/128), LRA % (1/134), NA- 2.6% (12/466) IMC 2/2 IMC 2/13

28 Conclusions The risk of high-risk adenomas at 2 nd surveillance was influenced by both baseline and 1 st surveillance finding (accumulated risk)

29 Conclusions The risk of high-risk adenomas at 2 nd surveillance was influenced by both baseline and 1 st surveillance finding (accumulated risk) Highest risk when HRA at both previous colonoscopies (54%! )

30 Conclusions The risk of high-risk adenomas at 2 nd surveillance was influenced by both baseline and 1 st surveillance finding (accumulated risk) Highest risk when HRA at both previous colonoscopies (54%! ) Risk of CRC at 2 nd surveillance was paradoxically slightly higher in LRA/NA groups (longer intervals, more invasive)

31 Conclusions The risk of high-risk adenomas at 2 nd surveillance was influenced by both baseline and 1 st surveillance finding (accumulated risk) Highest risk when HRA at both previous colonoscopies (54%! ) Risk of CRC at 2 nd surveillance was paradoxically slightly higher in LRA/NA groups (longer intervals, more invasive) These findings support the yield of shorter intervals in early detection of high-risk findings