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During follow-up of patients in the PPT, Laiyemo et al found that, although many low-risk patients have been verutilizing surveillance colonoscopy, underutilization as common among high- risk patients (Gastroenterolgy 2008;134:A111).
Abstract
hose with 1–2 small tubular adenomas, and 11.9% of hose with 3 tubular adenomas at baseline. Other igh-risk baseline findings also were associated with high ates of advanced neoplasia on surveillance, such as baseine large adenomas (15.5%), villous adenomas (16.1%), igh-grade dysplasia (17.4%), and cancer (34.8%). Because he subjects in the veteran study are likely to be of higher isk than the PPT subjects owing to differences in gender, ge, and family history, it is not surprising that the bsolute risks of advanced adenoma recurrence were omewhat higher. Ultimately, the question we must ask and answer is his: What risk of advanced adenoma recurrence is apropriate? Although a higher number will be associated ith a greater chance of missed opportunities to prevent ancer, a lower number will be associated with overutiization of scarce health care resources and avoidable omplications. Unfortunately, we lack sufficient knowldge of the true natural history of adenomas to adeuately answer this vital question. Laiyemo et al have elped to shed light on the importance of understanding he predictive power of risk factors for advanced adeoma recurrence. Their study suggests that future guideines may need to incorporate polyp location in risk tratification, and that the number of polyps may be less mportant than previously believed. Importantly, during assive follow-up of patients in the PPT, Laiyemo et al ound that, although many low-risk patients have been verutilizing surveillance colonoscopy, underutilization as common among high-risk patients (Gastroenterolgy 2008;134:A111). Therefore, not only are further studes needed to validate and improve the criteria used to tratify risk, but interventions are required to improve dherence to current guidelines as we strive to make hem increasingly evidence based. Until more data are vailable, it would be appropriate to follow the published ostpolypectomy surveillance guidelines.