Factors Driving 3-Year Colonoscopy Follow-Up for Low-Risk Adenomas

Summary and Comment |
March 9, 2017

Factors Driving 3-Year Colonoscopy Follow-Up for Low-Risk Adenomas

  1. Douglas K. Rex, MD

Factors included African-American or Asian patient race, findings of multiple adenomas or serrated polyps, and recommendation by a nongastroenterologist endoscopist.

  1. Douglas K. Rex, MD

It is well known that colonoscopy is often used at shorter-than-recommended intervals for screening and surveillance. Nongastroenterologists have been shown to be more likely to overuse colonoscopy.

To identify factors associated with endoscopist choice of a shorter-than-recommended colonoscopy screening interval (3 vs. 5 years) in patients with low-risk adenomas, researchers evaluated data from 1560 persons with 1 or 2 low-risk adenomas who participated in a chemoprevention trial of vitamin D and calcium.

Three-year follow-up was recommended in 38% of participants. In a multivariate analysis, factors significantly associated with selection of a short interval were African-American or Asian/Pacific Islander patient race, family history of colorectal cancer, finding of multiple adenomas or concomitant serrated polyps, and less-than-excellent quality of bowel preparation.

The percentage of recommendations for a short interval varied widely across 11 recruitment centers (14%–77%). Nongastroenterologist endoscopists were more likely to recommend short intervals.

Actual colonoscopy findings at 3-year and 5-year follow-ups, respectively, were nearly identical: multiple adenomas, 39% and 42%; advanced adenoma, 8% for both; clinically significant serrated polyp, 10% for both; and cancers, 4 and 1.


These data indicate that the endoscopist remains an important determining factor in the recommendation of short surveillance intervals. Short intervals in African-Americans might reflect general concerns about increased colorectal cancer risk in this group, but the increased rate among Asian/Pacific Islanders is difficult to understand. Short intervals in persons with positive family history are more easily understood, but guidelines do not recommend a shortened interval in the absence of Lynch syndrome. Regardless, these results indicate that shortening the colonoscopy interval for any of these reasons is not justified and support current postpolypectomy surveillance colonoscopy recommendations.

Note to readers: At the time NEJM Journal Watch reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Editor Disclosures at Time of Publication

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Covidien; Olympus Corporation America; Endo-Aid Ltd.; Endochoice; Boston Scientific; Paion AG; Ironwood Pharmaceuticals; Colonary Solutions; Novo Nordisk Inc.; Medscape Gastroenterology Grant / Research support: Braintree Laboratories Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology (associate editor); GI Journal Watch; Austin Journal of Gastroenterology; World Journal of Gastrointestinal Pharmacology & Therapeutics Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Forces (AGA, ACG, ASGE) (Chair)


Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.