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. 2021 Jan 22;16(1):e0245211.
doi: 10.1371/journal.pone.0245211. eCollection 2021.

Risk stratification for advanced colorectal neoplasia based on the findings of the index and first surveillance colonoscopies

Munenori Honda  1 , Hideaki Naoe  1 , Ryosuke Gushima  1 , Hideaki Miyamoto  1 , Masakuni Tateyama  1 , Kouichi Sakurai  2 , Yasushi Oda  3 , Yoshitaka Murakami  4 , Yasuhito Tanaka  1
Affiliations

Risk stratification for advanced colorectal neoplasia based on the findings of the index and first surveillance colonoscopies

Munenori Honda et al. PLoS One. .

Abstract

Risk stratification by index colonoscopy is well established for first surveillance endoscopy, but whether the previous two colonoscopies affect the subsequent advanced neoplasias has not been established. Therefore, the subsequent risk based on the findings of the index and first surveillance colonoscopies were investigated. This retrospective, cohort study was conducted in two clinics and included participants who had undergone two or more colonoscopies after index colonoscopy. High-risk was defined as advanced adenoma (≥ 1 cm, or tubulovillous or villous histology, or high-grade dysplasia). Based on the findings of the index and first surveillance colonoscopies, patients were classified into four categories: category A (both colonoscopy findings were normal), category B (no high-risk findings both times), category C (one time high-risk finding), and category D (high-risk findings both times). The incidence of subsequent advanced neoplasia was examined in each category. A total of 13,426 subjects were included and surveyed during the study periods. The subjects in category D had the highest risk of advanced neoplasia (27.4%, n = 32/117). The subjects in category A had the lowest risk (4.0%, n = 225/5,583). The hazard ratio for advanced neoplasia of category D compared to category A was 9.90 (95% Confidence interval 6.82-14.35, P<0.001). Classification based on the findings of index and first surveillance colonoscopies more effectively stratifies the risk of subsequent advanced neoplasia, resulting in more proper allocation of colonoscopy resources after two consecutive colonoscopies.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of enrollment in this study.
Fig 2
Fig 2. Cumulative Incidence of ANs according to each group after index and first surveillance colonoscopies.
Fig 3
Fig 3. Cumulative Incidence of ANs in each Category by index and first surveillance colonoscopy.
(a): Cumulative Incidence of AN after the first surveillance colonoscopy in each category. (b): Cumulative Incidence of AN after the index colonoscopy by the index colonoscopy findings alone.
See this image and copyright information in PMC

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