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. 2024 Apr 1;7(4):e244611.
doi: 10.1001/jamanetworkopen.2024.4611.

Surveillance Colonoscopy Findings in Older Adults With a History of Colorectal Adenomas

Jeffrey K Lee  1 , Abhik Roy  2 , Christopher D Jensen  1 , Jennifer T Chan  2 , Wei K Zhao  1 , Theodore R Levin  1 , Jessica Chubak  3   4 , Ethan A Halm  5 , Celette S Skinner  6   7   8 , Joanne E Schottinger  9   10 , Nirupa R Ghai  9   10 , Andrea N Burnett-Hartman  11 , Aruna Kamineni  3 , Natalia Udaltsova  1 , Douglas A Corley  1
Affiliations

Surveillance Colonoscopy Findings in Older Adults With a History of Colorectal Adenomas

Jeffrey K Lee et al. JAMA Netw Open. .

Abstract

Importance: Postpolypectomy surveillance is a common colonoscopy indication in older adults; however, guidelines provide little direction on when to stop surveillance in this population.

Objective: To estimate surveillance colonoscopy yields in older adults.

Design, setting, and participants: This population-based cross-sectional study included individuals 70 to 85 years of age who received surveillance colonoscopy at a large, community-based US health care system between January 1, 2017, and December 31, 2019; had an adenoma detected 12 or more months previously; and had at least 1 year of health plan enrollment before surveillance. Individuals were excluded due to prior colorectal cancer (CRC), hereditary CRC syndrome, inflammatory bowel disease, or prior colectomy or if the surveillance colonoscopy had an inadequate bowel preparation or was incomplete. Data were analyzed from September 1, 2022, to February 22, 2024.

Exposures: Age (70-74, 75-79, or 80-85 years) at surveillance colonoscopy and prior adenoma finding (ie, advanced adenoma vs nonadvanced adenoma).

Main outcomes and measures: The main outcomes were yields of CRC, advanced adenoma, and advanced neoplasia overall (all ages) by age group and by both age group and prior adenoma finding. Multivariable logistic regression was used to identify factors associated with advanced neoplasia detection at surveillance.

Results: Of 9740 surveillance colonoscopies among 9601 patients, 5895 (60.5%) were in men, and 5738 (58.9%), 3225 (33.1%), and 777 (8.0%) were performed in those aged 70-74, 75-79, and 80-85 years, respectively. Overall, CRC yields were found in 28 procedures (0.3%), advanced adenoma in 1141 (11.7%), and advanced neoplasia in 1169 (12.0%); yields did not differ significantly across age groups. Overall, CRC yields were higher for colonoscopies among patients with a prior advanced adenoma vs nonadvanced adenoma (12 of 2305 [0.5%] vs 16 of 7435 [0.2%]; P = .02), and the same was observed for advanced neoplasia (380 of 2305 [16.5%] vs 789 of 7435 [10.6%]; P < .001). Factors associated with advanced neoplasia at surveillance were prior advanced adenoma (adjusted odds ratio [AOR], 1.65; 95% CI, 1.44-1.88), body mass index of 30 or greater vs less than 25 (AOR, 1.21; 95% CI, 1.03-1.44), and having ever smoked tobacco (AOR, 1.14; 95% CI, 1.01-1.30). Asian or Pacific Islander race was inversely associated with advanced neoplasia (AOR, 0.81; 95% CI, 0.67-0.99).

Conclusions and relevance: In this cross-sectional study of surveillance colonoscopy yield in older adults, CRC detection was rare regardless of prior adenoma finding, whereas the advanced neoplasia yield was 12.0% overall. Yields were higher among those with a prior advanced adenoma than among those with prior nonadvanced adenoma and did not increase significantly with age. These findings can help inform whether to continue surveillance colonoscopy in older adults.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Levin reported receiving grants from the National Cancer Institute (NCI), National Institutes of Health (NIH) during the conduct of the study and receiving research support from Freenome, Inc. Dr Chubak reported receiving grants from the NCI during the conduct of the study and receiving grants from the NIH outside the submitted work. Dr Schottinger reported receiving grants from the NIH to the institution outside the submitted work. Dr Burnett-Hartman reported receiving grants from the NCI, NIH to the institution during the conduct of the study. Dr Kamineni reported receiving grants from the NCI during the conduct of the study. Dr Corley reported receiving grants from the NCI during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Colorectal Cancer and Advanced Neoplasia Yields at Surveillance Colonoscopy by Age Group and Prior Adenoma Findings
Yields were calculated using 12 or more months as the time interval between the surveillance colonoscopy and the index colonoscopy. AA indicates advanced adenoma; NAA, nonadvanced adenoma.
See this image and copyright information in PMC

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