Effect of Serrated Polyps and High-grade Dysplasia at Index Colonoscopy on Risk of Metachronous High-risk Adenomas
Primary Purpose
Colorectal Cancer, Colon Adenoma
Status
Recruiting
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Standard Colonoscopy
Sponsored by
About this trial
This is an interventional prevention trial for Colorectal Cancer focused on measuring sessile serrated polyps, traditional serrated adenomas, high-grade dysplasia, high-risk adenoma, cancer prevention, Colonoscopy
Eligibility Criteria
Inclusion Criteria:
- Patients 45-80 who underwent colonoscopy from 2009 to 2022 at the Montreal University Hospital Center (CHUM) with 1+ SL or HGD detected at index colonoscopy and lacking follow-up within or beyond the surveillance interval recommended by 2020 USMSTF guidelines.
Exclusion Criteria:
- 1) Patients with a diagnosis of inflammatory bowel disease;
- 2) Hereditary CRC syndromes;
- 3) CRC at index colonoscopy;
- 4) Serrated polyposis syndrome;
- 5) Life expectancy too short to benefit from colonoscopy;
- 6) Follow-up colonoscopy not yet due according to USMSTF guidelines. Patients with concomitant HRA and SL at index will be invited to participate if the index (or last) colonoscopy was performed more than 1 year ago. This is based on the high rates of HRA we identified in our retrospective study posing increased risks for these patients.
Sites / Locations
- Centre Hospitalier de l'Université de MontréalRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Colonoscopy
Arm Description
Standard colonoscopy: All optically diagnosed polyps will be removed and sent to the CHUM pathology laboratory for histopathological evaluation according to institutional standards.
Outcomes
Primary Outcome Measures
Rate of TMAN detection after index detection of serrated lesions
the rate of total metachronous advanced neoplasia (TMAN) detection after index detection of serrated lesions [sessile serrated polyps (SSPs), traditional serrated adenomas (TSAs)]
Rate of metachronous high-risk adenoma (HRA) after index detection of high-grade dysplasia (HGD)
the rate of metachronous high-risk adenoma (HRA) after index detection of high-grade dysplasia (HGD)
Secondary Outcome Measures
Rate of T-MAN detection for concomitant index SSP+low-risk adenoma (LRA); index SSP+ high-risk adenoma (HRA); index SSP alone
The rate of T-MAN detection for concomitant index SSP+low-risk adenoma (LRA); index SSP+ high-risk adenoma (HRA); index SSP alone
Rate of T-MAN detection according to number, size, location, and dysplasia status of index SSPs
The rate of T-MAN detection according to number, size, location, and dysplasia status of index SSPs
Rate of metachronous HRA detection for index HGD alone
The rate of metachronous HRA detection for index HGD alone
Rate of metachronous HRA detection for index HGD according to number, size, location, of index HGD
The rate of metachronous HRA detection for index HGD according to number, size, location, of index HGD
Rate of metachronous high-risk serrated lesion (SL) for concomitant index SSP+LRA; index SSP+HRA; index SSP alone; index SSP all synchronous findings included; index TSA a ll synchronous findings included
The rate of metachronous high-risk serrated lesion (SL) for concomitant index SSP+LRA; index SSP+HRA; index SSP alone; index SSP all synchronous findings included; index TSA all synchronous findings included
Rate of metachronous high-risk SL detection according to number, size, location, and dysplasia status of index SSPs
The rate of metachronous high-risk SL detection according to number, size, location, and dysplasia status of index SSPs
Rate of metachronous HRA for concomitant index SSP+LRA; index SSP+HRA; index SSP alone; index SSP all synchronous findings included; index TSA all synchronous findings included
The rate of metachronous HRA for concomitant index SSP+LRA; index SSP+HRA; index SSP alone; index SSP all synchronous findings included; index TSA all synchronous findings included
Rate of metachronous HRA detection according to number, size, location, and dysplasia status of index SSPs
The rate of metachronous HRA detection according to number, size, location, and dysplasia status of index SSPs
Rate of T-MAN and metachronous HRA detection for the serrated lesion (SL) and HGD groups
The rate of T-MAN and metachronous HRA detection for the serrated lesion (SL) and HGD groups stratified by number of years of surveillance delay
Rate of metachronous advanced SL and metachronous HRA detection for the serrated lesion (SL) group
The rate of metachronous advanced SL and metachronous HRA detection for the serrated lesion (SL) group stratified by number of years of delay at time of endoscopy from surveillance intervals recommended by guidelines
Adenoma detection rates (ADR) and advanced adenoma detection rates at follow-up
Adenoma detection rates (ADR) and advanced adenoma detection rates at follow-up stratified by number of years of delay at time of endoscopy from surveillance intervals recommended by guidelines
Full Information
NCT ID
NCT05355363
First Posted
April 4, 2022
Last Updated
March 8, 2023
Sponsor
Centre hospitalier de l'Université de Montréal (CHUM)
1. Study Identification
Unique Protocol Identification Number
NCT05355363
Brief Title
Effect of Serrated Polyps and High-grade Dysplasia at Index Colonoscopy on Risk of Metachronous High-risk Adenomas
Official Title
Effect of Serrated Polyps and High-grade Dysplasia at Index Colonoscopy on Risk of Metachronous High-risk Adenomas
Study Type
Interventional
2. Study Status
Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 27, 2023 (Actual)
Primary Completion Date
September 1, 2023 (Anticipated)
Study Completion Date
December 1, 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre hospitalier de l'Université de Montréal (CHUM)
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
During colonoscopy, the endoscopist will document colonoscopy indication; BBPS score; withdrawal time; adenoma and polyp detection rate at index and follow-up colonoscopy; completeness of polypectomy; polyp location, size, surface, morphology (Paris classification), histopathology; complications.
Detailed Description
Colorectal cancer (CRC) ranks second among worldwide cancer related deaths and third in terms of cancer incidence. Colonoscopy-based screening programs have been established to reduce CRC morbidity and mortality. Multiple guidelines have established surveillance recommendations for repeat colonoscopies based on findings at index colonoscopy. Serrated lesions (SLs), including sessile serrated polyps/adenomas (SSP) and traditional serrated adenomas (TSA) have become of increased interest for their role as precursors of CRC. The optimal timing of follow-up colonoscopies after detection of SLs has been controversial as studies looking into optimal surveillance timing are lacking. The US Multi Society Task Force (USMSTF) 2020 guidelines recommend 5-10y surveillance intervals for detection of 1-2 SSPs, 3-5y for 3-4 SSPs, 3y for >4 SSPs or TSA. In contrast, the 2020 European Society of Gastrointestinal Endoscopy (ESGE) Guidelines state that 1-10mm SLs do not require follow-up. It is unclear what the appropriate surveillance intervals is for patients with SLs which is evidenced by diverging recommendations from USMSTF/ESGE. High-grade dysplasia (HGD) is an exceedingly rare finding in colorectal polyps. The current literature on the yield of colonoscopy after index HGD is sparse, with conflicting data on risk of metachronous HRA due to low numbers of included HGD leading to high variability in reported outcomes.
The primary aim of this study is to determine the rate of metachronous advanced neoplasia (TMAN) detection after index detection of serrated lesions [sessile serrated polyps (SSPs), traditional serrated adenomas (TSAs)], and metachronous high-risk adenoma (HRA) after index detection of high-grade dysplasia (HGD).
Patient with SL or HGD diagnosed from 2010-2022 with lack of follow-up will be contacted by phone, then invited to undergo follow-up colonoscopy. Data collected will include patient age; sex; ASA class; past medical history; family history of CRC; procedure date; name of endoscopist; colonoscopy indication; BBPS score; withdrawal time; adenoma and polyp detection rate at index and follow-up colonoscopy; completeness of polypectomy; polyp location, size, surface, morphology (Paris classification), histopathology; complications, immediate and late (14 days).
We expect a higher percentage of high-risk lesions in our study group compared to our retrospective findings due to follow-up delays. As there is no published literature on the subject, our assumptions will be relative to our retrospective cohort. Assuming 60% participation in our study (patients deceased, unable to be contacted, received follow-up elsewhere, do not fit inclusion criteria), we expect 362 out of 603 patients to be enrolled in the SL group and 75 out of 124 in the HGD group. Assuming a 35% high-risk lesion (T-MAN) detection in the SL group compared to 22.1% detected retrospectively, we expect to include 127 cases of T-MAN. Assuming a 40% high-risk lesion (metachronous HRA) detection in the HGD group compared to 23.8% detected retrospectively [given the longer surveillance delays for these patients (7y) with 1% already with CRC at 1.8y median follow-up] we expect to include 30 cases of metachronous HRA. To perform univariate regression, we require inclusion of 10 patients with T-MAN in the SL group (minimum sample size: 29) and 10 patients with metachronous HRA in the HGD group (minimum sample size: 25). To perform our multivariate analyses, we require inclusion of 30 patients with T-MAN in the SL group (minimum sample size: 86) and 30 patients with metachronous HRA in the HGD group (minimum sample size: 75). Descriptive analysis with presentation of crude numbers, proportions, or medians with interquartile range will be used to present patient, procedure, and polyp outcomes. The rate of T-MAN in the SL group and metachronous HRA in the HGD group will be reported as proportions with exact 95% confidence intervals (CI). Primary outcomes will be illustrated using Kaplan Meier survival analyses for each group. We will perform COX proportional hazards regression to determine the effects of polyp size, location, and synchronous polyp status (no adenoma, LRA, or HRA) on risk of T-MAN, and effects of polyp size and location on risk of metachronous HRA for the SL and HGD groups respectively. Comparisons will be presented as Hazard ratios (HR) with 95% CI. We will perform multivariate COX regression to determine the effects of confounders on development of T-MAN or metachronous HRA. Our model will be adjusted family history of CRC and smoking status. Further confounders such as age, sex, and aspirin use will be evaluated in sensitivity analyses for possible inclusion in the multivariate analysis. The effect of duration of surveillance delays on risk of T-MAN or metachronous HRA will be evaluated using logistic regression. A two-tailed p<0.05 will be considered statistically significant for all analyses.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer, Colon Adenoma
Keywords
sessile serrated polyps, traditional serrated adenomas, high-grade dysplasia, high-risk adenoma, cancer prevention, Colonoscopy
7. Study Design
Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
prospective, multi-endoscopist, single center, single group assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
730 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Colonoscopy
Arm Type
Experimental
Arm Description
Standard colonoscopy: All optically diagnosed polyps will be removed and sent to the CHUM pathology laboratory for histopathological evaluation according to institutional standards.
Intervention Type
Diagnostic Test
Intervention Name(s)
Standard Colonoscopy
Intervention Description
Standard colonoscopy: All optically diagnosed polyps will be removed and sent to the CHUM pathology laboratory for histopathological evaluation according to institutional standards.
Primary Outcome Measure Information:
Title
Rate of TMAN detection after index detection of serrated lesions
Description
the rate of total metachronous advanced neoplasia (TMAN) detection after index detection of serrated lesions [sessile serrated polyps (SSPs), traditional serrated adenomas (TSAs)]
Time Frame
1 year
Title
Rate of metachronous high-risk adenoma (HRA) after index detection of high-grade dysplasia (HGD)
Description
the rate of metachronous high-risk adenoma (HRA) after index detection of high-grade dysplasia (HGD)
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Rate of T-MAN detection for concomitant index SSP+low-risk adenoma (LRA); index SSP+ high-risk adenoma (HRA); index SSP alone
Description
The rate of T-MAN detection for concomitant index SSP+low-risk adenoma (LRA); index SSP+ high-risk adenoma (HRA); index SSP alone
Time Frame
1 year
Title
Rate of T-MAN detection according to number, size, location, and dysplasia status of index SSPs
Description
The rate of T-MAN detection according to number, size, location, and dysplasia status of index SSPs
Time Frame
1 year
Title
Rate of metachronous HRA detection for index HGD alone
Description
The rate of metachronous HRA detection for index HGD alone
Time Frame
1 year
Title
Rate of metachronous HRA detection for index HGD according to number, size, location, of index HGD
Description
The rate of metachronous HRA detection for index HGD according to number, size, location, of index HGD
Time Frame
1 year
Title
Rate of metachronous high-risk serrated lesion (SL) for concomitant index SSP+LRA; index SSP+HRA; index SSP alone; index SSP all synchronous findings included; index TSA a ll synchronous findings included
Description
The rate of metachronous high-risk serrated lesion (SL) for concomitant index SSP+LRA; index SSP+HRA; index SSP alone; index SSP all synchronous findings included; index TSA all synchronous findings included
Time Frame
1 year
Title
Rate of metachronous high-risk SL detection according to number, size, location, and dysplasia status of index SSPs
Description
The rate of metachronous high-risk SL detection according to number, size, location, and dysplasia status of index SSPs
Time Frame
1 year
Title
Rate of metachronous HRA for concomitant index SSP+LRA; index SSP+HRA; index SSP alone; index SSP all synchronous findings included; index TSA all synchronous findings included
Description
The rate of metachronous HRA for concomitant index SSP+LRA; index SSP+HRA; index SSP alone; index SSP all synchronous findings included; index TSA all synchronous findings included
Time Frame
1 year
Title
Rate of metachronous HRA detection according to number, size, location, and dysplasia status of index SSPs
Description
The rate of metachronous HRA detection according to number, size, location, and dysplasia status of index SSPs
Time Frame
1 year
Title
Rate of T-MAN and metachronous HRA detection for the serrated lesion (SL) and HGD groups
Description
The rate of T-MAN and metachronous HRA detection for the serrated lesion (SL) and HGD groups stratified by number of years of surveillance delay
Time Frame
1 year
Title
Rate of metachronous advanced SL and metachronous HRA detection for the serrated lesion (SL) group
Description
The rate of metachronous advanced SL and metachronous HRA detection for the serrated lesion (SL) group stratified by number of years of delay at time of endoscopy from surveillance intervals recommended by guidelines
Time Frame
1 year
Title
Adenoma detection rates (ADR) and advanced adenoma detection rates at follow-up
Description
Adenoma detection rates (ADR) and advanced adenoma detection rates at follow-up stratified by number of years of delay at time of endoscopy from surveillance intervals recommended by guidelines
Time Frame
1 year
10. Eligibility
Sex
All
Minimum Age & Unit of Time
45 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients 45-80 who underwent colonoscopy from 2009 to 2022 at the Montreal University Hospital Center (CHUM) with 1+ SL or HGD detected at index colonoscopy and lacking follow-up within or beyond the surveillance interval recommended by 2020 USMSTF guidelines.
Exclusion Criteria:
1) Patients with a diagnosis of inflammatory bowel disease;
2) Hereditary CRC syndromes;
3) CRC at index colonoscopy;
4) Serrated polyposis syndrome;
5) Life expectancy too short to benefit from colonoscopy;
6) Follow-up colonoscopy not yet due according to USMSTF guidelines. Patients with concomitant HRA and SL at index will be invited to participate if the index (or last) colonoscopy was performed more than 1 year ago. This is based on the high rates of HRA we identified in our retrospective study posing increased risks for these patients.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel von Renteln, Md
Organizational Affiliation
Centre hospitalier de l'Université de Montréal (CHUM)
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centre Hospitalier de l'Université de Montréal
City
Montréal
State/Province
Quebec
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Julie Fleury
Phone
514-890-8000
Ext
30917
Email
julie.fleury.chum@ssss.gouv.qc.ca
First Name & Middle Initial & Last Name & Degree
Daniel Von Renteln, MD
First Name & Middle Initial & Last Name & Degree
Roupen Djinbachian, MD
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Effect of Serrated Polyps and High-grade Dysplasia at Index Colonoscopy on Risk of Metachronous High-risk Adenomas
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