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Thinking Big About Small Adenomas: Moving Toward “Precision Surveillance”

Imperiale, Thomas F. MD1,2,3

American Journal of Gastroenterology: December 2018 - Volume 113 - Issue 12 - p 1760–1762
doi: 10.1038/s41395-018-0397-9

Quality metrics and technological advances for colonoscopy are contributing to detection of more diminutive and small adenomas, increasing the proportion of persons undergoing surveillance for non-advanced neoplasia. In this issue, Kim and colleagues report surveillance colonoscopy findings in average-risk Koreans who had one or more adenomas on a first screening colonoscopy and found a similar risk of metachronous advanced neoplasia between those with 1-2 non-advanced adenoma (the “low-risk adenoma” group) and those with 3 or more small adenomas. The validity, generalizability, and clinical implications of the findings are considered along with recent similar studies. In sum, these studies support expanding the low-risk subgroup to include up to four diminutive tubular adenomas and perhaps persons with up to four small tubular adenomas. They also prompt consideration of “precision surveillance” that considers features of not just the polyps, but of the patient and endoscopist.

1Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. 2Center for Innovation, Health Services Research and Development, The Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA. 3Regenstrief Institute, Inc, Indianapolis, IN, USA.

Correspondence: T.F.I. (email:

Received 18 September 2018; accepted 25 September 2018; Published online 23 October 2018

© The American College of Gastroenterology 2018. All Rights Reserved.
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