Colorectal Adenoma
Conditions
Keywords
Screening colonoscopy, Surveillance, Advanced colorectal adenoma
Brief summary
A retrospective observational study to evaluate the risk of metachronous advanced colorectal neoplastic (ACRN) among individuals with varying numbers of non-advanced adenomas (NAA) detected during screening colonoscopy
Detailed description
Colorectal cancer (CRC) is the third most commonly diagnosed malignancy worldwide and the second leading cause of cancer-related mortality. In recent years, with increasing westernization of diet and lifestyle, both the incidence and prevalence of CRC in China have risen sharply. CRC has become the most common gastrointestinal malignancy in the country, ranking second in incidence and fifth in mortality among all cancers. Screening colonoscopy and appropriate surveillance intervals can substantially reduce CRC-related deaths. The latest 2020 U.S. Multi-Society Task Force (USMSTF) guidelines classify patients with 1-2 non-advanced adenomas (NAAs), 3-4 NAAs, and \>4 NAAs as having low-, intermediate-, and high-risk colonoscopic findings, respectively, and recommend surveillance intervals of 7-10 years, 3-5 years, and 3 years for these groups. However, accumulating evidence suggests that the risk of developing metachronous advanced colorectal neoplastic lesions (ACRN) in individuals with 3-4 NAAs may be comparable to those with only 1-2 NAAs, raising concerns regarding the appropriateness of current surveillance recommendations. Using a real-world, endoscopy database, this study systematically evaluates the association between different NAA counts and the subsequent risk of ACRN, providing evidence to inform optimization of post-polypectomy surveillance intervals.
Interventions
OTHERNo Intervention: Observational Cohort
No Intervention: Observational Cohort
Sponsors
Fudan University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* First-time screening colonoscopy * Only non-advanced adenomas (no villous features, no high-grade dysplasia, and diameter \<10 mm) were detected during first-time screening colonoscopy * Individuals with at least one surveillance colonoscopy * Complete electronic medical record and pathology information
Exclusion criteria
* Inadequate bowel preparation (BBPS \< 6) * Emergency colonoscopy * History of colorectal cancer * Incomplete pathology information or incompletely resected polyps * Screening colonoscopies performed by endoscopists with a low dynamic adenoma detection rate (ADR \< 15%) * Follow-up duration \< 6 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Metachronous Advanced Colorectal Neoplasia | Through study completion, an average of 1 month | Metachronous advanced colorectal neoplasia is defined as advanced adenoma (≥10 mm, villous component, or high-grade dysplasia) or colorectal cancer detected at any follow-up colonoscopy after the baseline index colonoscopy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Metachronous Colorectal Neoplasia | Through study completion, an average of 1 month | Metachronous colorectal neoplasia is defined as any adenoma or colorectal cancer detected at any follow-up colonoscopy after the baseline index colonoscopy. |
Countries
China
Outcome results
None listed