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Volume 328:901-906 April 1, 1993 Number 13 Next

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ABSTRACT

Background The identification and removal of adenomatous polyps and post-polypectomy surveillance are considered to be important for the control of colorectal cancer. In current practice, the intervals between colonoscopies after polypectomy are variable, often a year long, and not based on data from randomized clinical trials. We sought to determine whether follow-up colonoscopy at three years would detect important colonic lesions as well as follow-up colonoscopy at both one and three years.

Methods Patients were eligible if they had one or more adenomas, no previous polypectomy, and a complete colonoscopy and if all their polyps had been removed. They were randomly assigned to have follow-up colonoscopy at one and three years or at three years only. The two study end points were the detection of any adenoma, and the detection of adenomas with advanced pathological features (defined as those >1 cm in diameter and those with high-grade dysplasia or invasive cancer).

Results Of 2632 eligible patients, 1418 were randomly assigned to the two follow-up groups, 699 to the two-examination group and 719 to the one-examination group. The percentage of patients with adenomas in the group examined at one and three years was 41.7 percent, as compared with 32.0 percent in the group examined at three years (P = 0.006). The percentage of patients with adenomas with advanced pathological features was the same in both groups (3.3 percent).

Conclusions Colonoscopy performed three years after colonoscopic removal of adenomatous polyps detects important colonic lesions as effectively as follow-up colonoscopy after both one and three years. An interval of at least three years is recommended before follow-up examination after colonoscopic removal of newly diagnosed adenomatous polyps. Adoption of this recommendation nationally should reduce the cost of post-polypectomy surveillance and screening.

Source Information

From the National Polyp Study Headquarters, Memorial Sloan-Kettering Cancer Center, New York (S.J.W., A.G.Z., M.N.H., S.S.S., R.C.K., M. Shike); Mallory Institute of Pathology, Boston City Hospital, Boston (M.J.O., L.G.); Mount Sinai Hospital, New York (J.D.W.); Veterans Affairs Medical Center, Minneapolis (J.B.); Valley Presbyterian Hospital, Van Nuys, Calif. (M. Schapiro); Milwaukee County Medical Complex, Milwaukee (E.T.S.); Cedars-Sinai Medical Center, Los Angeles (J.P.); and Massachusetts General Hospital, Boston (F.A.). The following are other members of the National Polyp Study Workgroup who participated in this study: Memorial Sloan-Kettering Cancer Center, New York: C.J. Lightdale, H. Gerdes, L. Hornsby-Lewis, M. Edelman, M. Fleisher, B. Diaz, J. Lapidus, B. Flehinger, and R.A. McMahon; Strang Clinic, New York: C. Miller; Mount Sinai Hospital, New York: A. Szporn, N. Harpaz, M. Khilnani, and S. Yessayan; Veterans Affairs Medical Center, Minneapolis: H. Ansel, S. Ewing, and T. Dobson; Milwaukee County Medical Complex, Milwaukee: W. Hogan, J. Helm, R. Komorowski, and E. McLaughlin; St. Luke's Hospital, Racine, Wis.: J. Geenen, R. Venu, G.K. Johnson, and N. DeBoer; Massachusetts General Hospital, Boston: S. Hedberg, P. Shellito, D. Hall, G. Dickersin, and N. Horton; Cedars-Sinai Medical Center, Los Angeles: J. Sherman, J.A. Hamlin, S. Geller, and M. Kojimoto; Valley Presbyterian Hospital, Van Nuys, Calif.: M. Auslander, D. Kasimian, L. Kussin, and C. Scoggins; and Mallory Institute of Pathology, Boston (Pathology Review Center): C. Magrath.

Address reprint requests to Dr. Winawer at the Gastroenterology and Nutrition Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.

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