U.K. Criteria May Better Stratify for Colorectal Neoplasia Risk

May better identify high-risk patients warranting a one-year clearing colonoscopy

MONDAY, Dec. 17 (HealthDay News) -- Using U.K. risk stratification criteria might better identify post-polypectomy patients in the United States at high-risk for advanced colorectal neoplasia, according to research published in the Dec. 18 issue of the Annals of Internal Medicine.

María Elena Martínez, Ph.D., from Moores Cancer Center and the University of California San Diego, and colleagues pooled data from four prospective studies to compare risk for advanced colorectal neoplasia at one-year colonoscopy among patients cross-classified by U.S. and U.K. surveillance guidelines. Data were analyzed from 3,226 post-polypectomy patients with six- to 18-month follow-up colonoscopies.

The researchers found that, based on U.S. criteria, advanced neoplasia was detected one year after polypectomy in 3.8 and 11.2 percent of lower-risk and higher-risk patients, respectively. Based on U.K. criteria, 4.4, 9.9, and 18.7 percent of low-risk, intermediate-risk, and high-risk patients, respectively, presented with advanced neoplasia. High-risk patients accounted for 12.1 percent of all U.K. patients. Using U.K. criteria, all U.S. lower-risk patients were defined as low-risk. However, additional patients were also classified as low-risk because the U.K. guidelines do not consider histologic features. Using the U.K. definitions, higher-risk U.S. patients were distributed across the three categories. Using U.K. criteria, 26.3 percent of those with advanced neoplasia were classified to a higher-risk category and 7.0 percent to a lower-risk category, with 19.0 percent benefiting from earlier detection. Substituting U.S. guidelines with U.K. guidelines resulted in an estimated 0.03 additional colonoscopy every five years per patient.

"Application of the U.K. guidelines in the United States could identify a subset of high-risk patients who may warrant a one-year clearing colonoscopy, without substantially increasing colonoscopy rates," the authors write.

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