Younger Patients Do Not Develop More Advanced Polyps on Surveillance Colonoscopy Than Their Index Colonoscopy When...

Colonic polyp surveillance guidelines are based on data from patients 50 and above. Given the recent lowering for colorectal cancer (CRC) screening to age 45, the aim of this study was to assess whether existing colonic polyp surveillance guidelines are appropriate to use in younger patients.

We performed a retrospective cohort study of patients who underwent 2 colonoscopies within a 10-year period. Five Risk Stratification Groups (RSG) were developed based on surveillance colonoscopy interval times recommended by the US Multi-Society Task Force (USMSTF) on CRC, and changes in RSG from index to surveillance colonoscopy were compared between 3 age cohorts-those below 45, those 45 to 49, and those 50 and above. Further analysis was performed for patients whose RSG worsened from index to surveillance colonoscopy, as this was defined as an inappropriate surveillance interval.

A total of 1895 patients were included in the final analysis. A multivariate regression model showed that a worsened RSG was not significantly associated with age group, both when comparing below 45 to those 50 and above [odds ratio (OR)=0.840, 95% confidence interval (CI): 0.504-1.399, P=0.50] and when comparing those 45 to 49 to those 50 and above (OR=1.416, 95% CI: 0.905-2.216, P=0.13). Only being female was found to be statistically associated with worsened RSG after controlling for other variables (OR=0.652, 95% CI: 0.486-0.875, P<0.01).

Our study found that younger cohorts of patients, both below 45 and those 45 to 49, are not statistically more likely to develop more advanced polyps necessitating a shorter time to surveillance colonoscopy compared with patients 50 years and above. This finding supports using existing colonic polyp surveillance colonoscopy guidelines that were developed for patients 50 years and above in both patients below 45 and those 45 to 49 years old.