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Thinking Big About Small Adenomas: Moving Toward "Precision Surveillance".
Thomas F Imperiale1,1,1
1Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. Center for Innovation, Health Services Research and Development, The Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA. Regenstrief Institute, Inc, Indianapolis, IN, USA.
The American Journal of Gastroenterology
|October 25, 2018
Summary
Colonoscopy advances detect more small polyps, leading to increased surveillance. New research suggests expanding the low-risk adenoma group to include up to four small polyps may be appropriate.
Area of Science:
- Gastroenterology
- Endoscopy
- Cancer Prevention
Background:
- Technological advancements in colonoscopy enhance the detection of diminutive and small adenomas.
- This leads to a growing population requiring surveillance for non-advanced neoplasia.
- Recent studies investigate optimal surveillance strategies for individuals with a history of adenomas.
Discussion:
- The study by Kim et al. examined surveillance colonoscopy findings in average-risk Koreans with prior adenomas.
- It compared the risk of metachronous advanced neoplasia in patients with 1-2 non-advanced adenomas versus those with 3 or more small adenomas.
- Findings suggest similar risks between these groups, challenging traditional risk stratification.
Key Insights:
- The risk of metachronous advanced neoplasia is comparable between patients with 1-2 non-advanced adenomas and those with 3 or more small adenomas.
- These findings support broadening the definition of the low-risk adenoma subgroup.
- The study advocates for including individuals with up to four diminutive or small tubular adenomas in this expanded low-risk category.
Outlook:
- Future research should validate these findings across diverse populations.
- Consideration of "precision surveillance" incorporating patient and endoscopist factors is recommended.
- This approach aims to personalize colorectal cancer surveillance protocols for improved efficacy and resource allocation.