PMID- 28549732
OWN - NLM
STAT- MEDLINE
DCOM- 20181005
LR  - 20181005
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 87
IP  - 3
DP  - 2018 Mar
TI  - Metachronous colon polyps in younger versus older adults: a case-control study.
PG  - 657-665
LID - S0016-5107(17)31914-4 [pii]
LID - 10.1016/j.gie.2017.05.011 [doi]
AB  - BACKGROUND AND AIMS: The incidence of colorectal cancer in the United States has 
      decreased substantially in individuals aged 50 and older. In contrast, it is
      increasing in young adults. The polyp characteristics on baseline and follow-up
      colonoscopy in young adults are not well characterized. We describe the polyp
      characteristics on baseline and follow-up colonoscopy in adults <40 years and
      determined factors associated with the occurrence of metachronous, advanced
      neoplasia or high-risk (HR) polyp features. We compared the occurrence of
      metachronous advanced neoplasia in young adults with those 50 years and older to 
      assess whether postpolypectomy surveillance guidelines seem appropriate for
      polyp-bearing adults less than age 40 years. METHODS: Patients <40 years of age
      with >1 polyp removed on colonoscopy followed by a postpolypectomy colonoscopy
      were eligible. The primary outcome was the occurrence of advanced neoplasia or HR
      polyp features on follow-up colonoscopy. Secondary endpoints included factors
      associated with metachronous advanced neoplasia in young adults. The occurrence
      of metachronous advanced neoplasia in young adults was compared with a cohort of 
      patients aged 50 years and older. RESULTS: Included were 128 patients with a mean
      age of 34.9 years; 124 patients (97%) had adenomas and 7% had sessile serrated
      polyps (SSPs). Advanced neoplasia was seen in 35% of patients at baseline. The
      median follow-up time was 33.6 months. Metachronous advanced neoplasia was
      identified in 7% of patients on follow-up colonoscopy. Baseline factors
      associated with metachronous advanced neoplasia included the presence of an SSP
      (hazard ratio, 7.8; 95% CI, 1.09-56.3; P = .041) with a trend in those with
      advanced neoplasia (hazard ratio, 3.4; 95% confidence interval, .89-12.8; P =
      .072). The occurrence of metachronous advanced neoplasia did not differ between
      the young and older cohorts (7% vs 12.2%, P = .58); however, young adults were
      less likely to have HR polyp features on follow-up (8.6% vs 20.3%, P = .008).
      CONCLUSIONS: More than 1 in 3 adults <40 years old undergoing colonoscopy had
      advanced neoplasia on baseline colonoscopy. The occurrence of metachronous
      advanced neoplasia in young adults is similar to older adults and appears to be
      associated with the size, pathology, and number of baseline polyps. Our data
      suggest young polyp-bearing adults may undergo postpolypectomy colonoscopy at
      intervals currently recommended by national guidelines. Confirmation in larger
      studies is warranted.
CI  - Copyright (c) 2018 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Nagpal, Sajan Jiv Singh
AU  - Nagpal SJS
AD  - Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
FAU - Mukhija, Dhruvika
AU  - Mukhija D
AD  - Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
FAU - Sanaka, Madhusudhan
AU  - Sanaka M
AD  - Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio,
      USA.
FAU - Lopez, Rocio
AU  - Lopez R
AD  - Department of Quantitative and Health Sciences, Cleveland Clinic, Cleveland,
      Ohio, USA.
FAU - Burke, Carol A
AU  - Burke CA
AD  - Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio,
      USA.
LA  - eng
PT  - Journal Article
DEP - 20170523
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Case-Control Studies
MH  - Colon/pathology
MH  - Colonic Neoplasms/epidemiology/etiology/*pathology
MH  - Colonic Polyps/complications/*pathology
MH  - Colonoscopy/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Analysis
EDAT- 2017/05/28 06:00
MHDA- 2018/10/06 06:00
CRDT- 2017/05/28 06:00
PHST- 2016/05/17 00:00 [received]
PHST- 2017/05/11 00:00 [accepted]
PHST- 2017/05/28 06:00 [pubmed]
PHST- 2018/10/06 06:00 [medline]
PHST- 2017/05/28 06:00 [entrez]
AID - S0016-5107(17)31914-4 [pii]
AID - 10.1016/j.gie.2017.05.011 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2018 Mar;87(3):657-665. doi: 10.1016/j.gie.2017.05.011. Epub
      2017 May 23.