Two or More Advanced Lesions or High-Grade Dysplasia Predict Shorter Surveillance Intervals Than Current Recommendation
Douglas K. Rex, MD, MASGE, reviewing Kolb JM, Austin GL. Clin Gastroenterol Hepatol 2021 May 12.
Since 2012, the Multi-Society Task Force on Colorectal Cancer has recommended that patients with an advanced colorectal lesion (adenoma or sessile serrated lesion [SSL] ≥10 mm, adenoma with high-grade dysplasia or villous elements, SSL with dysplasia, or traditional serrated adenoma) undergo colonoscopy in 3 years.
In a retrospective analysis of 1120 patients with advanced lesions at a single U.S. center, 18.5% of patients received a surveillance recommendation other than 3 years. Short intervals were associated with high-grade dysplasia (odds ratio [OR], 4.33) or at least 2 advanced lesions (OR, 2.28). Longer intervals were more common than too-short intervals and were associated with flat polyps, with the largest lesion 12 mm or larger in diameter.
COMMENTIt’s interesting to see that most of the discordant intervals were too long rather than too short. This probably would vary depending on the center. Endoscopists should remember that recommending intervals that are too long carries medical-legal risk with interval cancer.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Kolb JM, Austin GL. Histology, size and number of advanced polyps are associated with guideline discordant surveillance recommendations. Clin Gastroenterol Hepatol 2021 May 12. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2021.05.016)
