Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis

Abstract

ObjectiveTo review and summarise the evidence on the prevalence of colorectal adenomas and cancers at a follow-up screening colonoscopy after negative index colonoscopy, stratified by interval between examinations and by sex.DesignSystematic review and meta-analysis of all available studies.Data sourcesPubMed, Web of Science, and Embase. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings.Eligibility criteriaStudies assessing the outcome of a follow-up colonoscopy among participants at average risk for colorectal cancer with a negative previous colonoscopy (no adenomas).Results28 studies were identified, including 22 cohort studies, five cross sectional studies, and one case-control study. Findings for an interval between colonoscopies of one to five, five to 10, and more than 10 years were reported by 17, 16, and three studies, respectively. Summary estimates of prevalences of any neoplasm were 20.7% (95% confidence interval 15.8% to 25.5%), 23.0% (18.0% to 28.0%), and 21.9% (14.9% to 29.0%) for one to five, five to 10, and more than 10 years between colonoscopies. Corresponding summary estimates of prevalences of any advanced neoplasm were 2.8% (2.0% to 3.7%), 3.2% (2.2% to 4.1%), and 7.0% (5.3% to 8.7%). Seven studies also reported findings stratified by sex. Summary estimates stratified by interval and sex were consistently higher for men than for women.ConclusionsAlthough detection of any neoplasms was observed in more than 20% of participants within five years of a negative screening colonoscopy, detection of advanced neoplasms within 10 years was rare. Our findings suggest that 10 year intervals for colonoscopy screening after a negative colonoscopy, as currently recommended, may be adequate, but more studies are needed to strengthen the empirical basis for pertinent recommendations and to investigate even longer intervals.Study registrationProspero CRD42019127842.

Low Risk of Advanced Neoplasms for up to 20 Years After Negative Colonoscopy Result: Potential for Personalized Follow-up Screening Intervals

“…A recent systematic review and meta-analysis reported ADN prevalences at follow-up colonoscopy within 10 years of approximately 3%. 3 The overall prevalences in our study (4.1%-6.4% within 1-10 years) were well within the range of ADN prevalences (0.6%-9.4%) of the 28 studies included in the review. Only little evidence for even longer intervals is available.…”

“…Patients were classified according to the most advanced of the following findings: CRC, advanced adenoma (defined as presence of at least 1 adenoma with at least 1 of the following features: >1 cm in size, tubulovillous or villous components, high-grade dysplasia) other adenoma, hyperplastic or unspecified polyp, or none of these. 3,4…”

Future Prospects of Colorectal Cancer Screening: Characterizing Interval Cancers

“…These guidelines are based on recent evidence [ 8 , 9 , 10 , 11 , 12 ] showing that the long-term CRC risk in patients with non-advanced neoplasia is not higher than that in the general population. If organized screening is not available, the repetition of colonoscopy 10 years after a negative colonoscopy is recommended [ 13 , 14 ]. However, these guidelines have been recently published; no previous standard definition for post-colonoscopy CRC was available.…”

Unacceptable variation in screening colonoscopy

“…Heisser and colleagues’ (doi:10.1136/bmj.l6109) linked meta-analysis of colorectal cancer and adenoma prevalence in the years following a negative colonoscopy shows that while neoplasms (including adenomas) were observed in more than 20% of participants within five years, advanced neoplasms were rare even after 10 years (2.1% in men, 1.8% in women) 1. The authors concluded that a 10 year screening interval after negative colonoscopy, as currently recommended,2 could be adequate 1…”

“…Both studies used empirical analyses to assess outcomes following colonoscopy, identify substantial variations in expected outcomes, and explore potential sources of heterogeneity. Heisser and colleagues showed that the risk of advanced neoplasia after negative index colonoscopy is low 1. Extending the testing interval or the use of non-invasive alternatives such as triage by immunochemical testing might be appropriate for many of these patients, because they are least likely to benefit from repeat colonoscopy based screening.…”