Browsing by Author "Butterly, Lynn F."

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    Association of small versus diminutive adenomas and the risk for metachronous advanced adenomas: data from the New Hampshire Colonoscopy Registry
    (Elsevier, 2019) Anderson, Joseph C.; Rex, Douglas K.; Robinson, Christina; Butterly, Lynn F.; Medicine, School of Medicine
    Background and Aims Limited data are available to investigate the impact of index adenoma size on the risk of metachronous advanced adenomas. Our goal was to examine the impact of having small (5-9 mm) versus diminutive (<5 mm) adenomas on the future risk of advanced adenomas within the categories for polyps <1 cm currently used in the United States: 1 to 2 and 3 or more tubular adenomas. Methods We included data from individuals participating in the statewide, population-based New Hampshire Colonoscopy Registry (NHCR). Groups were based on index findings: (1) 1 to 2 adenomas <5 mm (both diminutive), (2) 1 to 2 adenomas <1 cm (one or both small), (3) 3 to 10 adenomas <5 mm (all diminutive), (4) 3 to 10 adenomas <1 cm (one or more small), and (5) advanced adenomas (AA). AAs were defined as adenomas ≥1cm or those with villous elements or high-grade dysplasia or colorectal cancer (CRC). Outcomes were the absolute and adjusted risk of metachronous AAs. Covariates included age, sex, body mass index, family history of CRC, lifestyle factors, presence of serrated polyps, and time since the index examination. Results After adjusting for the covariates, we observed that having 1 to 2 adenomas with at least one 5 to 9 mm adenoma (adjusted odds ratio [AOR], 1.54; 95% confidence interval [CI], 1.12-2.11), 3 to 10 diminutive adenomas (AOR, 1.75; 95% CI, 1.03-2.95), 3 to 10 adenomas <1 cm (1 or more small) (AOR, 2.14; 95% CI, 1.39-3.29) or AAs (AOR, 2.77; 95% CI, 2.05-3.74) were associated with an increased risk for metachronous AA compared with having 1 to 2 diminutive adenomas. A further stratification of group 2 showed that those with exactly 2 small adenomas had an absolute risk of future AA of 7.6% (11/144) (95% CI, 4.3%-13.2%), higher than the absolute risk in the 1 to 2 diminutive polyp group, and similar to the risk for 3 to 10 adenomas of 8.2% (95% CI, 5.4-11.9). Conclusions For individuals with 1 to 2 adenomas <1 cm, having at least 1 small adenoma increased the metachronous risk of AA compared with having only diminutive adenomas. Furthermore, the subset with 2 small adenomas had a risk of future AA similar to the risk for 3 to 10 adenomas. These data suggest that individuals with at least 1 small adenoma may be at higher risk for future AAs and thus require closer follow-up than those with only diminutive adenomas. These data may be valuable to guideline committees for the creation of future surveillance recommendations.
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    Endoscopist Adenoma Per Colonoscopy Detection Rates and Risk for Post Colonoscopy Colorectal Cancer: Data From New Hampshire Colonoscopy Registry
    (Elsevier, 2023-11-21) Anderson, Joseph C.; Rex, Douglas K.; Mackenzie, Todd A.; Hisey, William; Robinson, Christina M.; Butterly, Lynn F.; Medicine, School of Medicine
    Background and Aims Adenomas per colonoscopy (APC) may be a better measure of colonoscopy quality than adenoma detection rate (ADR) since it credits endoscopists for each detected adenoma. There are few data examining the association between APC and post colonoscopy colorectal cancer (PCCRC) incidence. We used data from the New Hampshire Colonoscopy Registry (NHCR) to examine APC and PCCRC risk. Methods We included NHCR patients with an index exam and at least one follow up event, either a colonoscopy or a CRC diagnosis. Our outcome was PCCRC defined as any CRC diagnosed > 6 months after an index exam. The exposure variable was endoscopist specific APC quintiles of 0.25, 0.40, 50 and 0.70. Cox regression was used to model the hazard of PCCRC on APC, controlling for age, sex, year of index exam, index findings, bowel preparation and having more than 1 surveillance exam. Results In 32,535 patients, a lower hazard for PCCRC (n=178) was observed for higher APCs as compared to APCs <0.25 (Reference) (0.25-<0.40:HR=0.35, 95% CI: 0.22-0.56;0.40-<0.50: HR=0.31, 95% CI: 0.20-0.49; 0.50-<0.70: HR=0.20, 95% CI: 0.11-0.36; and ≥0.70: HR=0.19, 95% CI: 0.09-0.37). When examining endoscopists with an ADR of at least 25%, an APC < 0.50 was associated with a significantly higher hazard than an APC > 0.50 (HR=1.65; 95% CI: 1.06-2.56). A large proportion of endoscopists, 1/5th (32/152; 21.1%), had an ADR >25 but an APC <0.50. Discussion Our novel data demonstrating lower PCCRC risk in exams performed by endoscopists with higher APCs suggest that APC could be a useful quality measure. Quality improvement programs may identify important deficiencies in endoscopist detection performance by measuring APC for endoscopists with ADR > 25%.
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    Higher Serrated Polyp Detection Rates are Associated with Lower Risk for Post Colonoscopy Colorectal Cancer: Data From the New Hampshire Colonoscopy Registry
    (Wolters Kluwer, 2023) Anderson, Joseph C.; Rex, Douglas K.; Mackenzie, Todd A.; Hisey, William; Robinson, Christina M.; Butterly, Lynn F.; Medicine, School of Medicine
    Introduction: We used New Hampshire Colonoscopy Registry data to examine the association between postcolonoscopy colorectal cancer (PCCRC) and sessile serrated detection rates (SSLDRs). Methods: We included patients with either a colonoscopy or a CRC diagnosis in the NH State Cancer Registry. PCCRC was any CRC diagnosed ≥ 6 months after index examination. Results: Of 26,901 patients, 162 were diagnosed with PCCRC. The hazard ratio for PCCRC was lowest for patients whose endoscopists had the highest SSLDR quintile (≥6%) (hazard ratio 0.29; 95% confidence interval 0.16-0.50). Discussion: Endoscopists with higher SSLDRs had lower risks of PCCRC. These data validate SSLDR as a clinically relevant quality measure.