Background & Aims

Surveillance guidelines for serrated polyps (SPs) are based on limited data on longitudinal outcomes of patients. We used the New Hampshire Colonoscopy Registry to evaluate risk of clinically important metachronous lesions associated with SPs detected during index colonoscopies.

Methods

We collected data from a population-based colonoscopy registry that has been collecting and analyzing data on colonoscopies across the state of New Hampshire since 2004, including rates of adenoma and SP detection. Patients completed a questionnaire to determine demographic characteristics, health history, and risk factors for colorectal cancer, and were followed from index colonoscopy through all subsequent surveillance colonoscopies. Our analyses included 5433 participants (median age, 61 years; 49.7% male) with 2 colonoscopies (median time to surveillance, 4.9 years). We used multivariable logistic regression models to assess effects of index SPs (n = 1016), high-risk adenomas (HRA, n = 817), low-risk adenomas (n = 1418), and no adenomas (n = 3198) on subsequent HRA or large SPs (>1 cm) on surveillance colonoscopy (metachronous lesions). Synchronous SPs, within each index risk group, were assessed for size and by histology. SPs comprise hyperplastic polyps, sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas. In this study, SSA/Ps and traditional serrated adenomas are referred to collectively as STSAs.

Results

HRA and synchronous large SP (odds ratio [OR], 5.61; 95% confidence interval [CI], 1.72−18.28), HRA with synchronous STSA (OR, 16.04; 95% CI, 6.95−37.00), and HRA alone (OR, 3.86; 95% CI, 2.77−5.39) at index colonoscopy significantly increased the risk of metachronous HRA compared to the reference group (no index adenomas or SPs). Large index SPs alone (OR, 14.34; 95% CI, 5.03−40.86) or index STSA alone (OR, 9.70; 95% CI, 3.63−25.92) significantly increased the risk of a large metachronous SP.

Conclusions

In an analysis of data from a population-based colonoscopy registry, we found index large SP or index STSA with no index HRA increased risk of metachronous large SPs but not metachronous HRA. HRA and synchronous SPs at index colonoscopy significantly increased risk of metachronous HRA. Individuals with HRA and synchronous large SP or any STSA could therefore benefit from close surveillance.

中文翻译：

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结肠镜检具上有锯齿状息肉的个体发生同步性高风险腺瘤和大锯齿状息肉的风险：来自新罕布什尔州结肠镜登记处的数据

背景与目标

锯齿状息肉（SP）的监视指南基于患者纵向结局的有限数据。我们使用了新罕布什尔州结肠镜检查登记处来评估在索引结肠镜检查中发现的与SP相关的临床重要的异时性病变的风险。

方法

我们从基于人群的结肠镜检查注册表中收集数据，该注册表自2004年以来一直在收集和分析新罕布什尔州的结肠镜检查数据，包括腺瘤和SP检测率。患者完成了一份调查问卷，以确定人口统计学特征，健康史和大肠癌的危险因素，并从索引结肠镜检查到所有随后的监测结肠镜检查随访。我们的分析包括5433名参与者（中位年龄61岁；男性49.7％）和2例结肠镜检查（监测中位时间4.9岁）。我们使用多变量logistic回归模型评估指数SP（n = 1016），高危腺瘤（HRA，n = 817），低危腺瘤（n = 1418）和无腺瘤（n = 3198）的影响监测结肠镜检查（同步病变）上的HRA或大SP（> 1厘米）。在每个指数风险组中，通过大小和组织学评估同步SP。SP包括增生性息肉，无柄锯齿状腺瘤/息肉（SSA / Ps）和传统的锯齿状腺瘤。在这项研究中，SSA / P和传统的锯齿状腺瘤统称为STSA。

结果

HRA和同步大SP（赔率[OR]为5.61； 95％置信区间[CI]为1.72-18.28），带有同步STSA的HRA（OR为16.04； 95％CI为6.95-37.00）和仅HRA（OR ，与参考组（无指标腺瘤或SPs）相比，在指标结肠镜检查时，，3.86； 95％CI，2.77-5.39）显着增加了同期HRA的风险。单独使用大型索引SP（OR，14.34； 95％CI，5.03-40.86）或单独使用STSA索引（OR，9.70； 95％CI，3.63-25.92）显着增加了大型异时SP的风险。

结论

在基于人群的结肠镜检查登记处的数据分析中，我们发现没有SPHR指数的大型SP或STSA指数增加了同期大SP的风险，但没有同期HRA。结肠镜检查中的HRA和同步SP显着增加了异时HRA的风险。因此，具有HRA和同步大型SP或任何STSA的个人可以从密切监视中受益。