Systematic Reviews
Copyright ©The Author(s) 2016.
World J Gastrointest Oncol. Dec 15, 2016; 8(12): 826-834
Published online Dec 15, 2016. doi: 10.4251/wjgo.v8.i12.826
Table 1 Articles summarizing the risk of neoplasia based on the histology of polyps seen at baseline colonoscopy
Ref.Sample sizeMedian follow-up, yrPredictorPrimary outcomeAbsolute risk of outcome (%)RR1 [95%CI]
RCT
Laiyemo et al[11]19054VillousACN9 (7-11) vs 5 (4-6)2.3 [1.5-3.4]
Bonithon-Kopp et al[9]5523HGDACN9.8 vs 5.51.9 [1.0-3.6]
Villous10.3 vs. 6.81.7 [0.8-3.7]
Pooled analysis
Martínez et al[14]8 studies3.9HGDACN16.0 (13.2-18.7) vs 10.6 (9.8-11.3)1.1 [0.8-1.4]
9167Villous16.8 (15.1-18.5) vs 9.7 (9.0-10.4)1.3 [1.1-1.5]
Meta-analysis
Saini et al[10]5 studies3HGDACN4% risk difference (0-8)1.8 [1.1-3.2]
Villous2% risk difference (-1 to 4)1.3 [1.0-1.7]
Prospective
Bertario et al[15]108610.5HGDCRC2.8 SIR (0.3-10.2) vs 0.52Not available
Tubulovillous VillousAny adenomaNot available1.3 [1.0-1.6]
1.8 [1.2-2.6]
2Lieberman et al[12]11935.5No adenomasACN2.4Ref
HGD176.8 [2.6-18.1]
Villous166.1 [2.5-14.7]
Chung et al[8]38084.5VillousACNNot available1.5 [0.7- 3.0]
Registry
Van Heijningen et al[13]29902HGDAA131.2 [0.8-1.8]
Villous82.0 [1.2-3.2]
HGDACN11Not available
Villous17
Table 2 Articles summarizing the risk of future colonic neoplasia based on the size of polyps seen at baseline colonoscopy
Ref.Sample sizeMedian follow-up, yrPredictorPrimary outcomeAbsolute risk of outcome (%)RR [95%CI]
RCT
Laiyemo et al[11]19054≥ 10 mmACN9 (7-11) vs 5 (4-6)0.9 [0.6-1.4]
Bonithon-Kopp et al[9]5523≥ 10 mmACN7.1 vs 7.81.1 [0.5-2.1]
Pooled analysis
Martínez et al[14]8 studies3.9< 5 mmACN8.7 (7.7-9.7)Ref
916710-19 mm15.9 (14.5-17.4)2.3 [1.8-2.8]
≥ 20 mm19.3 (16.4-22.3)3.0 [2.2-4.0]
Meta-analysis
Saini I et al[10]5 studies3≥ 10 mmACN2% risk difference (-2 to 6)1.4 [0.9-2.3]
Prospective
Bertario et al[15]108610.5≥ 20 mmAny adenomaNot available1.5 [1.1-2.1]
CRCSIRNot available
Baseline0.52 [0.3-0.9]
< 10 mm0.33 [0.1-0.9]
≥ 10 mm0.82 [0.3-1.8]
Lieberman et al[12]11935.5≥ 10 mmACN15.5 vs 2.46.4 [2.7-14.9]
Chung et al[8]38084.5≥ 10 mmACNNot available3.0 [1.8-5.1]
Registry
Van Heijningen et al[13]29902≥ 10 mmAA8 vs 41.7 [1.2-2.3]
Table 3 Articles summarizing the risk of colonic neoplasia based on the number of polyps seen at baseline colonoscopy
Ref.Sample sizeMedian follow-up, yrPredictorPrimary outcomeAbsolute risk of outcome (%)RR [95%CI]
RCT
Laiyemo et al[11]19054≥ 3 adenomasACN10 (7-14) vs 6 (5-7)1.5 [1.0-2.2]
Bonithon-Kopp et al[9]5523≥ 3 adenomasACN18.1 vs 5.02.7 [1.2-6.4]
Meta-analysis
Saini I et al[10]5 studies3≥ 3 adenomasACN5% risk difference (1-10)2.5 [1.1-6.0]
Prospective
1Lieberman et al[12]11935.51-2ACN4.61.9 [0.8-4.4]
≥ 311.95.0 [2.1-12.0]
Chung et al[8]38084.5≥ 3 adenomasACNNot available3.1 [1.5-6.6]
Registry
Van Heijningen et al[13]299021AA4Ref
271.6 [1.1-2.4]
382.1 [1.3-3.4]
4122.0 [0.9-4.6]
≥ 5183.3 [1.7-6.6]
Ng et al[18]49892AANot availableAdjusted OR
13.6 [2.6-5.0]
27.1 [4.9-10.4]
313.7 [0.9-4]
Table 4 Risk of concurrent and future advanced adenomas and colon cancer based on serrated polyps
Ref.Sample sizeMedian follow-up, yrPredictorPrimary outcomeAbsolute riskRisk [95%CI]
RCT
Holme et al[20]10021010.9≥ 10 mm serrated polypFuture CRC3.4 vs 1.4 cases/1000 patient yearsHR 3.3 [1.3-8.6]
Registry
Álvarez et al[17]5059NoneProximal l ≥ 10 mmACNNot available4.2 [1.7-10.2]
Distal l ≥ 10 mm2.6 [1.5-4.6]
Proximal HP1.6 [1.3-2.3]
Hiraoka et al[16]10199None≥ 10 mm serrated polypsACN4.0 [2.8-5.7]
CRCNot available3.3 [2.2-5.0]
Proximal CRC4.8 [2.5-8.4]
Hazewinkel et al[19]1426NoneProximal SPACNNot available2.4 [1.6-3.8]
Proximal HP2.0 [1.1-3.4]
Prox SSA/P3.0 [1.5-6.2]
≥ 10 SP4.0 [1.9-8.6]
≥ 10 mm HP3.2 [1.1-9.1]
≥ 10 mm SSA/P5.0 [1.7-14.9]
Ng et al[18]4989NoneSSAACNNot available4.5 [2.4-8.5]
Proximal SP2.2 [1.4-3.6]
≥ 10 mmSP59.3 [18.9-186.2]
≥ 3 SP4.9 [1.2-19.2]
≥ 3 non-advanced adenomas3.6 [2.6-5.0]
Schreiner et al[21]3121NoneProximal SPAA17.3 vs 10.01.9 [1.3-2.7]
≥ 1 cm SP27.3 vs 10.33.4 [1.7-6.7]
13715.5Proximal SPFuture
without adenomasAA5.1 vs 2.73.1 [1.6-6.2]
Proximal SP7.9 vs 6.31.2 [0.5-3.8]
with nonadvanced adenoma28.9 vs 14.72.3 [1.0-5.0]
Proximal SP
with advanced adenoma
Table 5 Current guideline recommendations for surveillance based on from United States Multi-society Task Force on colorectal cancer, British Society of Gastroenterology, and European Society of Gastrointestinal Endoscopy[5,27,28]
Organization and yearof guidelinesRecommendations for surveillance of adenomas
Baseline findingTiming of next exam, yr
USMSTF on CRC[5], 20121-2 small adenomas5-10
Adenoma with villous histology3
Adenoma with high grade dysplasia3
Adenoma ≥ 10 mm3
3-10 adenomas3
Serrated polyps:
< 10 mm no dysplasia5
≥ 10 mm3
Dysplasia3
Traditional serrated adenoma3
British Society of Gastroenterology[28], 20101-2 small adenomas5-10
3-4 small adenomas3
Adenoma ≥ 10 mm3
≥ 5 small adenomas1
≥ 3 at least one ≥ 10 mm1
European Society of Gastrointestinal Endoscopy[27], 2010High risk adenomas:3
Adenoma ≥ 10 mm
Adenomas with high grade dysplasia
Villous component
≥ 3 adenomas
Serrated polyp ≥ 10 mm
Serrated polyps with dysplasia
Not high risk adenomas10