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Polyp characteristics at screening colonoscopy and post-colonoscopy colorectal cancer mortality: a retrospective cohort study

  • Jasmin Zessner-Spitzenberg
    Affiliations
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

    Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
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  • Lena Jiricka
    Affiliations
    Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Clinical Biometrics, Medical University of Vienna, Vienna, Austria
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  • Elisabeth Waldmann
    Affiliations
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

    Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
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  • Lisa-Maria Rockenbauer
    Affiliations
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

    Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
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  • Jeremy Cook
    Affiliations
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

    Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
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  • Anna Hinterberger
    Affiliations
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

    Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
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  • Barbara Majcher
    Affiliations
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

    Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
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  • Aleksandra Szymanska
    Affiliations
    Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
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  • Arno Asaturi
    Affiliations
    Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
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  • Michael Trauner
    Affiliations
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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  • Monika Ferlitsch
    Correspondence
    Correspondence to: Monika Ferlitsch, MD, Dept. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Medical University of Vienna, Austria, Waehringer Guertel 18-20, 7i, 1090 Vienna, Austria.
    Affiliations
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria

    Quality Assurance Working Group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
    Search for articles by this author
Published:January 15, 2023DOI:https://doi.org/10.1016/j.gie.2023.01.021
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      ABSTRACT

      Background and Aims

      Polyp size and high grade dysplasia in polyps at screening colonoscopy are considered risk factors for post-colonoscopy colorectal cancer (PCCRC) development and death, which might be averted by surveillance colonoscopy. However, robust evidence backing these risk factors is lacking. We aimed to investigate whether polyp size or dysplasia grade are associated with PCCRC mortality.

      Methods

      This was a retrospective study including individuals of the Austrian Quality Certificate for Screening Colonoscopy scoped between 01/2007 and 12/2020. We investigated the association of polyp size and dysplasia in polyps with PCCRC mortality by Cox regression. Additionally, we assessed whether patients with certain polyp characteristics had similar risk for CRC death compared to the Austrian population by calculating standardized mortality ratios (SMR).

      Results

      316,001 individuals were included. After a median follow-up time of 5.27 years (95% CI 5.25-5.29), a significant association of polyp size 10-20 mm (HR 4.00, 95% CI 2.46-6.50, p <0.001) as well as high-grade dysplasia (HR 6.61, 95% CI 3.31-13.2, p<0.001) with PCCRC death was observed. PCCRC mortality was significantly lower than the expected CRC mortality in the general population in patients with polyps <10 mm and without high grade dysplasia (SMR 0.27, 95% CI 0.21-0.33, p<0.001), which was not observed for patients with polyps ≥10 mm or with high-grade dysplasia (SMR 2.05, 95% CI 1.64-2.57, p < 0.001).

      Conclusions

      Polyp size ≥10 mm and high-grade dysplasia are associated with PCCRC mortality in screening patients. This data suggests that these patients might benefit most from surveillance colonoscopy.

      Key words

      Abbreviations list:

      CRC (Colorectal cancer), PCCRC (Post-colonoscopy colorectal cancer), SSL (Sessile serrated lesion), TSA (Traditional serrated adenoma), USMSTF (US Multisociety Task Force on Colorectal Cancer), HGD (High grade dysplasia), HGIEN (High grade intraepithelial neoplasia), HR (Hazard ratio), CI (Confidence interval), SMR (Standardized Mortality Ratio)
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