Abstract
BACKGROUND AND AIMS—In the USA and many other countries, endoscopic surveillance of colorectal adenoma patients is now widely practised. However, the optimal frequency and mode of such surveillance are not yet established. The aim of this trial was to compare surveillance at one, two, or five year intervals using either flexible sigmoidoscopy or colonoscopy. METHODS—Analysis of a randomised trial of flexible sigmoidoscopy and colonoscopy over one, two, or five years after stratification for "high" or "low" risk of recurrent adenomas. The trial started in 1984. RESULTS—A total of 776 patients were stratified into "high" (n=307) and "low" (n=469) recurrence risk groups and randomised to flexible sigmoidoscopy or colonoscopy at varying intervals. Only 81 recurrent adenomas (30/81 were >1 cm in diameter) were detected in the 2307 person years of follow up within the surveillance study. Adenoma recurrence was significantly higher in the high risk group (relative rate 1.82; 95% confidence interval 1.2-2.9) but recurrence rates per 1000 person years were low and not significantly different in those surveyed by colonoscopy or flexible sigmoidoscopy. Loss to follow up was greatest in those having an annual examination compared with two or five yearly surveillance examinations. Despite surveillance, invasive cancer developed in four patients compared with an expected value of 9.12 for the general population in England (p=0.10); of these four patients who developed cancers, only one was detected by surveillance examination. CONCLUSIONS—Adenoma recurrence rates were much lower than expected in both high and low risk groups. This suggests that endoscopic surveillance should be targeted at high risk groups. A surveillance interval of five years was as effective as shorter intervals in terms of cancer prevention, and was associated with similar compliance to two yearly examinations. Keywords: adenoma; polyp; colorectal cancer; surveillance; colonoscopy
Full Text
The Full Text of this article is available as a PDF (121.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Atkin W. S., Morson B. C., Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992 Mar 5;326(10):658–662. doi: 10.1056/NEJM199203053261002. [DOI] [PubMed] [Google Scholar]
- JACKMAN R. J., MAYO C. W. The adenoma-carcinoma sequence in cancer of the colon. Surg Gynecol Obstet. 1951 Sep;93(3):327–330. [PubMed] [Google Scholar]
- Jørgensen O. D., Kronborg O., Fenger C. A randomized surveillance study of patients with pedunculated and small sessile tubular and tubulovillous adenomas. The Funen Adenoma Follow-up Study. Scand J Gastroenterol. 1995 Jul;30(7):686–692. doi: 10.3109/00365529509096314. [DOI] [PubMed] [Google Scholar]
- Morson B. President's address. The polyp-cancer sequence in the large bowel. Proc R Soc Med. 1974 Jun;67(6 Pt 1):451–457. [PMC free article] [PubMed] [Google Scholar]
- Müller A. D., Sonnenberg A. Protection by endoscopy against death from colorectal cancer. A case-control study among veterans. Arch Intern Med. 1995 Sep 11;155(16):1741–1748. doi: 10.1001/archinte.1995.00430160065007. [DOI] [PubMed] [Google Scholar]
- Newcomb P. A., Norfleet R. G., Storer B. E., Surawicz T. S., Marcus P. M. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst. 1992 Oct 21;84(20):1572–1575. doi: 10.1093/jnci/84.20.1572. [DOI] [PubMed] [Google Scholar]
- Rex D. K., Cutler C. S., Lemmel G. T., Rahmani E. Y., Clark D. W., Helper D. J., Lehman G. A., Mark D. G. Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997 Jan;112(1):24–28. doi: 10.1016/s0016-5085(97)70214-2. [DOI] [PubMed] [Google Scholar]
- Selby J. V., Friedman G. D., Quesenberry C. P., Jr, Weiss N. S. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992 Mar 5;326(10):653–657. doi: 10.1056/NEJM199203053261001. [DOI] [PubMed] [Google Scholar]
- Waye J. D., Braunfeld S. Surveillance intervals after colonoscopic polypectomy. Endoscopy. 1982 May;14(3):79–81. doi: 10.1055/s-2007-1021585. [DOI] [PubMed] [Google Scholar]
- Winawer S. J., Zauber A. G., Ho M. N., O'Brien M. J., Gottlieb L. S., Sternberg S. S., Waye J. D., Schapiro M., Bond J. H., Panish J. F. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993 Dec 30;329(27):1977–1981. doi: 10.1056/NEJM199312303292701. [DOI] [PubMed] [Google Scholar]
- van Stolk R. U., Beck G. J., Baron J. A., Haile R., Summers R. Adenoma characteristics at first colonoscopy as predictors of adenoma recurrence and characteristics at follow-up. The Polyp Prevention Study Group. Gastroenterology. 1998 Jul;115(1):13–18. doi: 10.1016/s0016-5085(98)70359-2. [DOI] [PubMed] [Google Scholar]