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Colonoscopy Guidelines After Polyp Removal May Be Flawed

Risk stratification scheme has limited ability to predict recurrence of advanced adenomas

TUESDAY, March 18 (HealthDay News) -- Current guidelines for postpolypectomy colonoscopy surveillance, based on whether the removed adenoma is a high-risk or low-risk lesion, have a limited ability to predict advanced adenoma recurrence, according to new study findings published in the March 18 issue of the Annals of Internal Medicine.

Adeyinka O. Laiyemo, M.D., of the National Cancer Institute in Bethesda, Md., and colleagues studied 1,905 participants of the Polyp Prevention Trial who had colorectal adenomas removed at baseline and follow-up colonoscopies at one and four years, in order to determine whether characteristics of adenomas at baseline predicted subsequent advanced adenoma recurrence.

During four years of follow-up, 6.6 percent of patients had an advanced and 33 percent had a non-advanced adenoma recurrence, the investigators found. The four-year risk of advanced adenomas was 9 percent among patients with high-risk adenomas at baseline, and 5 percent among those with low-risk adenomas at baseline, the researchers report. Although patients with high-risk adenomas at baseline had an increased risk of recurrence, the discrimination of the risk stratification scheme was relatively low, they note.

"If other studies confirm our findings, a review of the postpolypectomy guidelines to improve their ability to predict recurrence of important colorectal lesions may be warranted," the authors conclude.

Two co-authors report financial ties to Myriad Genetics and Stryker.

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