Risk of Metachronous Advanced Neoplasia After Colonoscopy in Patients With Different Index Findings

Area of Science:

• Gastroenterology
• Oncology
• Epidemiology

Background:

• Patients undergoing colonoscopy face risks of developing metachronous advanced neoplasia (AN).
• Accurate risk stratification is crucial for determining appropriate surveillance intervals.
• Index colonoscopy findings significantly influence the risk of future AN.

Purpose of the Study:

• To explore risk factors associated with metachronous AN.
• To refine risk stratification strategies based on distinct index colonoscopy findings.
• To inform personalized surveillance protocols for colonoscopy patients.

Main Methods:

• Retrospective cohort study of 3638 patients undergoing multiple colonoscopies in China (2012-2023).
• Cox regression analysis adjusted for covariates to estimate AN risk.
• Kaplan-Meier estimation for cumulative hazard and sensitivity analyses.

Main Results:

• In the non-advanced adenoma group, proximal adenomas, adenomas ≥6mm, and ≥3 adenomas increased AN risk.
• In the non-significant findings group, age ≥50, family history of CRC, and male sex increased AN risk.
• Patients with identified risk factors reached reference risk for AN earlier.

Conclusions:

• Independent risk factors for metachronous AN were identified across different baseline diagnostic subgroups in a Chinese population.
• Personalized risk stratification is facilitated by considering these identified risk factors.
• Risk profiles are essential for defining optimal colonoscopy surveillance intervals.