Influence of long-term colonoscopic surveillance on incidence of colorectal cancer and death from the disease in patients with precursors (adenomas)

Case-control studies and short term prospective studies have suggested that selected groups of patients with precursors of colorectal cancer may benefit from colonoscopic surveillance after initial removal of adenomas. The aim of the present study was to demonstrate such a possible benefit from long term ( 1-24 years) colonoscopic surveillance in a population of patients with all types of adenomas regardless of size and way of removal. Two thousand and forty-one patients with a first time diagnosis of colorectal adenoma were included in prospective surveillance between year 1978 and 2002. All adenomas were considered. Incidence of CRC and mortality from CRC was calculated, using age, sex, and calendar specific number of person years of follow-up for comparison with the standard Danish population. CRC was found in 27 patients, the expected number being 41 ( RR 0.65, 95% CI 0.43-0.95). Three of the 27 patients died from CRC, the expected number being 25 ( RR 0.12, 95% CI 0.03-0.36). A total of 6 289 colonoscopies resulted in severe complications in 20 patients and two died from complications. Long-term colonoscopic surveillance may reduce incidence of CRC as well as mortality in patients with sporadic adenomas. The benefit is reduced to a minor degree by complications from surveillance.