P3861 - Comparing the USMSTF 2020 and 2012 Post Polypectomy Risk Stratification Paradigms Using the New Hampshire Colonoscopy Registry

Nima Kamalpour, MD¹, Joseph C. Anderson, MD², Lynn Butterly, MD^3
1Dartmouth Hitchcock Medical Center, Wexford, PA; ²Dartmouth College, White River Junction, VT; ³Dartmouth Hitchcock Medical Center, Hanover, NH

Introduction: The objective of our study was to compare the recent 2020 and the prior 2012 United States Multi-society Task Force (USMSTF) guideline recommendations on surveillance colonoscopies and their ability to predict metachronous risk.

Methods: We compared the ability to predict metachronous neoplasia (advanced adenoma (AA), large serrated polyps (Large SP’s), and Colorectal Cancer (CRC)) individually and as a combined outcome in patients with index polyps based on the risk stratification paradigm for both the 2020 and 2012 guidelines. We compared the unadjusted risk for metachronous neoplasia as well as the long term risk of CRC based on both guidelines. After multivariable logistic regression we compared the discriminatory power of each guideline by calculating probabilities and modeling them with receiver operator curves (ROC) for metachronous neoplasia. We modeled the hazard of post colonoscopy CRC for each surveillance guideline using Cox's proportional hazards model and constructed ROC curves to assess the discriminatory ability of each guideline for the risk of CRC.

Results: The unadjusted and adjusted risks, Odds Ratio (OR), for all outcomes increased across all groups with higher risk index polyps for both guidelines (all p< 0.001 for unadjusted risks) (Table 1). The ROC curves were similar between the guidelines in discriminating metachronous neoplasia, with all outcomes (including CRC) being [2012: 0.63 (95% CI: 0.61-0.64), 2020: 0.63 (95% CI: 0.62-0.64)], Large SP [2012: 0.59 (95% CI: 0.57-0.61), 2020: 0.60 (95% CI: 0.58-0.62)], and AA [2012: 0.67 (95% CI: 0.65-0.68), 2020: 0.66 (95% CI: 0.65-0.68)]. The ROC curves based on the Cox regression models for the hazard of CRC were similar, with the 2020 guidelines at 0.737 (95% CI: 0.70-0.78) and the 2012 guidelines at 0.730 (95% CI: 0.69-0.77).

Discussion: The metachronous risk of AA, Large SP, and long term CRC risk, was similar when comparing the recent USMSTF 2020 and prior 2012 guidelines. Efforts should be continued to determine the optimal surveillance follow-up for multiple SSPs < 1 cm and HPs >1 cm.


Disclosures:


Nima Kamalpour, MD¹, Joseph C. Anderson, MD², Lynn Butterly, MD³. P3861 - Comparing the USMSTF 2020 and 2012 Post Polypectomy Risk Stratification Paradigms Using the New Hampshire Colonoscopy Registry, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.