Periprocedure adverse events requiring significant intervention were defined as major events (other events were minor) and were tracked during follow-up for at least 10 years. 380 includes 3121 asymptomatic veterans aged 50 to 75 years who underwent screening colonoscopy between 19. We aimed to describe adverse events during follow-up in a colonoscopy screening program after the baseline examination and examine factors associated with increased risk.Ĭooperative Studies Program no. Ewing, MD, Minneapolis Georgeĭata are limited regarding colonoscopy risk during long-term, programmatic colorectal cancer screening and follow-up. Campbell, MD, Kansas City, MO Theodore E. Schnell, MD, and Gregorio Chejfec, MD, Hines, IL Donald R. The authors also acknowledge other VA Cooperative Study Group 380 investigators: William V. The authors acknowledge Veterans Affairs Cooperative Studies Program 380, Grant Huang, PhD MPH, Director. Participants with baseline CRC, advanced adenomas, or 3+ small adenomas remained at increased risk for AN over 10 years when compared with Acknowledgments Using rigorous methods to acquire detailed data from a CRC screening cohort of asymptomatic individuals undergoing surveillance, we found strong evidence that baseline screening colonoscopy findings remain highly predictive of outcomes during the 10-year follow-up period, even after accounting for varying intensity of surveillance and other CRC risk factors. 21 Over 10 years of surveillance, 1915 (61.3%) Discussion The adenoma detection rate was 37.8% and the polyp detection rate was 54.0%. At baseline, the cecal intubation rate, assessed by photo documentation, was 97.7%. Although there were no quality metrics for colonoscopy at that time, CSP #380 developed metrics, recognizing that the quality of colonoscopy could impact both screening and surveillance outcomes. 21 The initial inclusion criteria included only VA participants with no previous structural colon examinations and no history of lower ResultsĪt baseline, 3121 subjects were enrolled and had screening colonoscopy from 1994 to 1997. The complete methods of CSP #380 were previously reported and are summarized here. Future work will examine the cause-specific factors associated with non-CRC mortality in these groups to 1) identify potential high-yield strategies for tailored non-CRC mortality risk reduction during CRC screening, and 2) better determine when competing risks of non-CRC mortality outweigh the benefit of follow up colonoscopy.In the prospective Department of Veterans Affairs (VA) Cooperative Studies Program Study #380 (CSP #380), 3121 asymptomatic veterans aged 50 to 75 underwent a screening colonoscopy between 19 across 13 VA medical centers and were then followed for 10 years. Neither race, NSAID use (including aspirin), or dietary factors impacted non-CRC mortality.ĬONCLUSIONS: In a Veteran CRC screening population, we found that high-risk adenomas or CRC on baseline colonoscopy were independently associated with increased non-CRC mortality within 10 years. On the other hand, increasing physical activity (HR 0.88, <0.001), family history of CRC (HR 0.75, =0.02), and increased BMI (HR 0.73-0.75, <0.01) were associated with reduced non-CRC mortality. Additionally, increasing age (HR 1.07, <0.001), modified Charlson score (HR 1.57 for 3-4 points, <0.001, compared to 0-2 points) and current smoking (HR 2.09, <0.001, compared to former and non-smokers) were associated with higher non-CRC mortality. The risk of non-CRC mortality was higher in Veterans with ≥3 small adenomas (HR 1.45, p=0.02), advanced adenomas (HR 1.34, p=0.04), or CRC (HR 3.00, =0.05) on baseline colonoscopy when compared to Veterans without neoplasia. During the 10-year follow-up period, 837 (27.0%) Veterans died from non-CRC causes. Information on comorbidities, family history, diet, physical activity, and medications were obtained from self-reported questionnaires at baseline. Hazard ratios (HR) for risk factors on non-CRC mortality were calculated by Cox Proportional Hazard model, adjusting for demographics, baseline comorbidities, and lifestyle factors. Those who died from CRC-specific causes were excluded from this analysis (n=18, 0.6%). Veterans were followed for 10 years or death, as verified in electronic medical records. METHODS: The Cooperative Studies Program (CSP) #380 cohort is comprised of 3,121 Veterans age 50-75 who underwent screening colonoscopy from 1994-97. PURPOSE: Examine whether baseline colonoscopy findings are associated with non-Colorectal Cancer (CRC) mortality in a Veteran screening population.īACKGROUND: Although screening colonoscopy findings are associated with future risk of CRC mortality, whether these findings are also associated with non- CRC mortality remains unknown.
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