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document
A randomized surveillance study of patients with pedunculated and small sessile tubular and tubulovillous adenomas . The Funen Adenoma Follow-up Study . BACKGROUND We wanted to assess the influence of various surveillance intervals on the risk of new neoplasia after removal of pedunculated and small sessile tubular and tubulovillous adenomas . METHODS After initial colonoscopic polypectomy patients were randomized to surveillance with either 2 years ( group A ) or 4 years ( group B ) between colorectal examinations . RESULTS The cumulated risk of a patient having new adenomas was 35.0 % ( 28.7-41.4 % ) in group A and 35.5 % ( 28.4-42.7 % ) in group B after 48 months . The risk increased to 44.9 % ( 36.0-53.9 % ) and 60.1 % ( 48.5-71.7 % ) , respectively , after 96 months . The risk of significant neoplasia ( carcinoma or adenoma with villous structure , severe dysplasia , or diameter > 10 mm ) was 5.2 % ( 2.3-8.1 % ) and 8.6 % ( 3.8-13.3 % ) after 48 months and 8.6 % ( 4.2-13.0 % ) and 17.4 % ( 7.6-27.2 % ) after 96 months . More than one adenoma at first examination was associated with higher risk of new adenomas . Furthermore , we found a tendency for age above 60 years and male gender to be associated with higher risk of new adenomas . More than two adenomas at first examination was the only factor found to be associated with a higher risk of new significant neoplasia . One patient in group A and two patients in group B developed cancer , which is not significantly different from the number expected ( 3.43 ) in the average Danish population ( RR = 0.9 , 0.2-2.6 ) . CONCLUSION After colonoscopy with removal of all polyps , colorectal examination at 4 years resulted in a similar risk of new adenomas compared with examinations at 2 and 4 years . However , new significant neoplasia tended to be more frequent when first surveillance was at 4 years . Extending the surveillance to 8 years also tended to increase the risk more in the group being examined every 4 years , but reduction of the number of surveillance examinations by more than 50 % and a probable reduction of complications from surveillance examinations themselves may justify a recommendation for the longest interval .
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Outcome_Physical
risk of new neoplasia
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Outcome_Physical
risk of a patient having new adenomas
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Outcome_Physical
significant neoplasia ( carcinoma or adenoma with villous structure , severe dysplasia , or diameter > 10 mm
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Outcome_Physical
higher risk of new adenomas
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Outcome_Physical
adenomas
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Outcome_Physical
risk of new significant neoplasia
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Outcome_Physical
cancer
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Outcome_Physical
risk of new adenomas
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Outcome_Physical
neoplasia
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Participant_Condition
pedunculated and small sessile tubular and tubulovillous adenomas
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Participant_Condition
initial colonoscopic polypectomy
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Participant_Age
age above 60 years
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Participant_Sex
male