Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Gupta, Samir; Lieberman, David A.; Anderson, Joseph C.; Burke, Carol A.; Dominitz, Jason A.; Kaltenbach, Tonya; Robertson, Douglas J.; Shaukat, Aasma; Syngal, Sapna; Rex, Douglas K.

doi:10.14309/ajg.0000000000000544

Cited by 182 publications

(278 citation statements)

References 110 publications

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“…Meanwhile, TNs and MS have superimposed effects on the occurrence of colorectal adenomas. Therefore, patients with both TNs and MS should be offered a screening colonoscopy as a high-risk group in accordance with colonoscopy guidelines [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Presence of Metabolic Syndrome and Thyroid Nodules in Subjects with Colorectal Polyps

2020

Med Sci Monit

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Background Thyroid nodules (TNs) and metabolic syndrome (MS) have been individually associated with colorectal polyps. However, the potential joint relationship between them in relation to colorectal polyps has not been fully evaluated. This study aimed to validate the association of TNs/MS and colorectal polyps/adenomas and to determine the risk of colonic polyps in patients with TNs/MS. Material/Methods A retrospective study was conducted on patients undergoing routine health checks in the First Affiliated Hospital of Wenzhou Medical University from July 2014 to August 2017. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for colorectal polyps/adenomas after adjusting for confounding factors. Then patients were divided into 4 groups according to whether they had TNs or MS. Relative excess risks of interaction, attributable proportion, and synergy index were used to determine the additive interaction of TNs and MS on colorectal polyps/adenomas. Results A total of 4514 eligible patients were included in this study. TNs and MS were confirmed to be independent risk factors for colorectal polyps/adenomas. Compared with the group of TNs(−)/MS(−), the odds ratios of TNs(+)/MS(+) in colorectal polyps (odds ratio [OR]: 3.031, 95% confidence interval [CI]: 2.262–4.062, P <0.05) or adenomas (OR: 2.894, 95% CI: 2.099–3.990, P <0.05) were significantly increased, and there was an interactive additive effect between TNs and MS. Conclusions TNs and MS have an associative and superimposing effect on the increased occurrence of colorectal adenomas. Colonoscopy screening should be advocated for patients with both of these diseases.

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Section: Discussionmentioning

confidence: 99%

Presence of Metabolic Syndrome and Thyroid Nodules in Subjects with Colorectal Polyps

2020

Med Sci Monit

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“…Index colonoscopy was defined as an initial colonoscopy for screening. LRAs were defined as 1 to 2 tubular adenomas measuring <10mm in size, and HRAs were defined as ≥3 adenomas or advanced adenomas [ 9 ]. Advanced adenomas were defined as adenomas with size ≥10 mm, villous histology, or high-grade dysplasia [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

“…As the utilization of colonoscopy increases, the detection of sporadic adenoma among young adults is becoming more common. Patients who undergo adenoma removal have a higher incidence of subsequent adenoma than those without adenoma [ 9 , 10 ]. Therefore, these patients need surveillance colonoscopy after adenoma removal [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patients who undergo adenoma removal have a higher incidence of subsequent adenoma than those without adenoma [ 9 , 10 ]. Therefore, these patients need surveillance colonoscopy after adenoma removal [ 9 , 10 ]. The surveillance interval is determined based on the probability of developing metachronous advanced CRN (ACRN).…”

Section: Introductionmentioning

confidence: 99%

“…The current guidelines regarding post-polypectomy surveillance focus on patients aged ≥50 years and do not provide clear recommendation for the surveillance of young patients aged <50 years with adenomas [ 9 , 10 ]. There is marked variability in clinicians’ surveillance recommendations for young patients with sporadic adenomas [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Risk of Metachronous Advanced Colorectal Neoplasia in Patients with Sporadic Adenomas Aged < 50 Versus ≥ 50 years: A Systematic Review and Meta-Analysis

Jung

Park

2021

JPM

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No specific recommendations are available for the surveillance of young patients aged <50 years undergoing polypectomy. We aimed to compare the risk of metachronous advanced colorectal neoplasia (ACRN) between patients aged ≥50 years and those aged <50 years who underwent polypectomy. Studies published between January 1980 and June 2020 that examined the risk of metachronous ACRN were searched. We performed a meta-analysis for the metachronous ACRN risk in patients with sporadic colorectal adenomas according to the age groups (≥50 vs. <50 years). Eight individual studies were included in the meta-analysis. The risk of metachronous ACRN was higher in patients aged ≥50 years than in those aged <50 years without significant heterogeneity (odds ratio (OR) (95% CI): 1.62 (1.34–1.96), I2 = 14%). The impact of the age group on the risk of metachronous ACRN was identified in both the low-risk (LRA) and high-risk (HRA) adenoma groups (≥50 vs. <50 years: LRA, OR 1.88 (95% CI 1.30–2.70); HRA, OR 1.50 [95% CI 1.13–2.00]). In conclusion, patients aged <50 years had a lower risk of metachronous ACRN than older patients. Young patients with sporadic adenomas do not require more intensive surveillance; rather, the surveillance interval may be extended in these patients.

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Colorectal Cancer Screening

Knudsen

Rutter

Peterse

et al. 2021

JAMA

158

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Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations.OBJECTIVE To provide updated model-based estimates of the benefits, burden, and harms of colorectal cancer screening strategies and to identify strategies that may provide an efficient balance of life-years gained (LYG) from screening and colonoscopy burden to inform the USPSTF. DESIGN, SETTING, AND PARTICIPANTS Comparative modeling study using 3 microsimulation models of colorectal cancer screening in a hypothetical cohort of 40-year-old US individuals at average risk of colorectal cancer.EXPOSURES Screening from ages 45, 50, or 55 years to ages 70, 75, 80, or 85 years with fecal immunochemical testing (FIT), multitarget stool DNA testing, flexible sigmoidoscopy alone or with FIT, computed tomography colonography, or colonoscopy. All persons with an abnormal noncolonoscopy screening test result were assumed to undergo follow-up colonoscopy. Screening intervals varied by test. Full adherence with all procedures was assumed. MAIN OUTCOME AND MEASURESEstimated LYG relative to no screening (benefit), lifetime number of colonoscopies (burden), number of complications from screening (harms), and balance of incremental burden and benefit (efficiency ratios). Efficient strategies were those estimated to require fewer additional colonoscopies per additional LYG relative to other strategies.RESULTS Estimated LYG from screening strategies ranged from 171 to 381 per 1000 40-year-olds. Lifetime colonoscopy burden ranged from 624 to 6817 per 1000 individuals, and screening complications ranged from 5 to 22 per 1000 individuals. Among the 49 strategies that were efficient options with all 3 models, 41 specified screening beginning at age 45. No single age to end screening was predominant among the efficient strategies, although the additional LYG from continuing screening after age 75 were generally small. With the exception of a 5-year interval for computed tomography colonography, no screening interval predominated among the efficient strategies for each modality. Among the strategies highlighted in the 2016 USPSTF recommendation, lowering the age to begin screening from 50 to 45 years was estimated to result in 22 to 27 additional LYG, 161 to 784 additional colonoscopies, and 0.1 to 2 additional complications per 1000 persons (ranges are across screening strategies, based on mean estimates across models). Assuming full adherence, screening outcomes and efficient strategies were similar by sex and race and across 3 scenarios for population risk of colorectal cancer. CONCLUSIONS AND RELEVANCEThis microsimulation modeling analysis suggests that screening for colorectal cancer with stool tests, endoscopic tests, or computed tomography colonography starting at age 45 years provides an efficient balance of colonoscopy burden and life-years gained.

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Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Cited by 182 publications

References 110 publications

Presence of Metabolic Syndrome and Thyroid Nodules in Subjects with Colorectal Polyps

Presence of Metabolic Syndrome and Thyroid Nodules in Subjects with Colorectal Polyps

Comparison of Risk of Metachronous Advanced Colorectal Neoplasia in Patients with Sporadic Adenomas Aged < 50 Versus ≥ 50 years: A Systematic Review and Meta-Analysis

Colorectal Cancer Screening

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