Changing Advanced/High-Risk Adenoma Definition Would Reduce Colonoscopies With Limited Delay in CRC Diagnoses
Douglas K. Rex, MD, MASGE, reviewing Jodal HC, et al. Gastroenterology 2023 May 3.
Patients with advanced or high-risk adenomas are recommended to undergo surveillance earlier than patients with low-risk adenomas. In the U.S., the traditional high-risk group classification for patients includes those with adenomas ≥1 cm, high-grade dysplasia or villous elements, or ≥3 adenomas. In 2020, the European Society of Gastrointestinal Endoscopy (ESGE) redefined the high-risk group as those with adenomas ≥1 cm, high-grade dysplasia, or ≥5 adenomas. A Polish study was used to create a novel definition of adenomas ≥20 mm or high-grade dysplasia.
Using national registries in Norway, investigators identified and studied a group of patients with cancer and a subcohort of patients with adenomas. The patients were diagnosed between 1993 and 2007 and followed for a median of 12.7 years.
The fraction of the adenoma cohort having high-risk findings was 52.7%, 45.2%, and 27% with the traditional, ESGE, and novel risk classification schemes, respectively. A diagnosis of colorectal cancer (CRC) would have been delayed in 3.4% of cases using the ESGE classification and 24.1% using the novel classification.
The low-risk adenoma cohorts had CRC risk below the general population risk using all 3 definitions of high risk.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Jodal HC, Wieszczy-Szczepanik P, Klotz D, et al. A comparison of risk classification systems of colorectal adenomas: a case cohort study. Gastroenterology 2023 May 3. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2023.04.028)