Clinical-alimentary tractColorectal Cancer in Patients Under Close Colonoscopic Surveillance
Section snippets
Materials and Methods
We have previously reported the essential features of the design and principal findings of the 3 multicenter randomized trials that form the basis for the current analyses.9, 10, 11 Institutional review board approval to perform the trials and collect the information that is reported herein was obtained from all participating centers in each study. Briefly, patients qualified for study by having at least one histologically documented large bowel adenoma of any size removed shortly before study
Results
A total of 2915 patients were randomized in the 3 trials. The characteristics of the participants differed only moderately among studies, and overall 71% were men, 85% were white, and the average age was 59.7 years (Table 1). Colonoscopic follow-up was essentially complete; 97% (n = 2836) of subjects had at least one examination after the qualifying colonoscopy, and in 91% (n = 2664) follow-up ended with a year-3 (third trial) or year-4 colonoscopy (trials 1 and 2) as per protocol. Most of the
Discussion
In our trials, we followed up 2915 patients with adenomas using surveillance protocols that called for complete colonoscopic examination; 26 of these patients were diagnosed with invasive colorectal cancer or high-grade dysplasia. Of the 19 cancers identified, 8 were stage II or greater; 2 of these cancers ultimately caused the death of the patients. Fifteen (79%) of the cancers were found during a surveillance examination and were apparently asymptomatic. Older age and greater number of
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2021, MedCitation Excerpt :Screening colonoscopy remains the most efficient modality recommended for early diagnosis and is recommended to all individuals older than 50 years.61,62 However, adenoma miss rate has been a rising concern in endoscopy-based diagnosis of colorectal cancer, despite the high accuracy of detection of colorectal cancer.63–65 This is of major clinical importance, as adenomas may progress into life-risking colorectal carcinomas.
Supported by a development award from the Foundation for Digestive Health and Nutrition. The parent studies were supported by grants CA 23108, CA46927, and CA 59005 from the National Institutes of Health.