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Endoscopy 2011; 43(7): 560-574
DOI: 10.1055/s-0030-1256306
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Systematic literature review and pooled analyses of risk factors for finding adenomas at surveillance colonoscopy

V.  de Jonge1 , J.  Sint Nicolaas1 , M.  E.  van Leerdam1 , E.  J.  Kuipers1 , 2 , S.  J.  O.  Veldhuyzen van Zanten3
  • 1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  • 2Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
  • 3Division of Gastroenterology, University of Alberta Hospital, Edmonton, Alberta, Canada
Further Information

Publication History

submitted 12 August 2010

accepted after revision 21 December 2010

Publication Date:
24 March 2011 (online)

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Commentaire de travail de V. de Jonge et al., pp. 560Endoscopy 2011; 43(07): 647-647
DOI: 10.1055/s-0031-1291725

Background and study aim: Colorectal cancer (CRC) screening guidelines recommend surveillance after polypectomy. There is variation in the surveillance intervals that are being advised. This variation also affects adherence. Surveillance intervals need to be based on risk factors at index. We therefore aimed to systematically review risk factors of adenoma findings at surveillance colonoscopy.

Methods: A systematic literature search was performed up to September 2009. Studies that reported on follow-up colonoscopy findings with stratification for index characteristics were included. Pooled relative risks (RR) were calculated using random effects models, and heterogeneity was determined by means of the I2 -statistic.

Results: A total of 27 studies met the inclusion criteria. The most important risk factors for adenoma findings were the presence on index colonoscopy of the following: advanced adenomas (RR: 1.81), ≥ 3 adenomas (RR: 1.64), size ≥ 10 mm (RR: 1.66), and age ≥ 60 years (RR: 1.65). The presence of villous adenomas, high grade dysplasia, proximal adenomas, and male gender were associated with less profound increases in RR. Marked variation in study design and substantial heterogeneity between studies was observed.

Conclusions: Convincing evidence exists that patients with advanced adenomas, ≥ 3 adenomas, adenomas ≥ 10 mm, or age ≥ 60 years have an increased risk of adenoma recurrence. The evidence for other baseline findings for an increased risk of adenoma recurrence is inconclusive. Marked variation and consistently lower RRs in studies of medium or low quality emphasize the necessity for well performed and well reported studies. Given the high impact of surveillance on patients and service providers, there is need for further assessment of the risk(s) of adenoma recurrence.

Appendix 1 – 3 are available online:

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V. de Jonge

Department of Gastroenterology and Hepatology,
Erasmus MC University Medical Center

's Gravendijkwal 230, room Hs 322-K
P.O. box 2040
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The Netherlands

Fax: +31-10-7034682

Email: v.dejonge@erasmusmc.nl