{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T03:44:00Z","timestamp":1765079040116,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"accepted":{"date-parts":[[2001,1,17]]},"published-print":{"date-parts":[[2001,7,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND AIMS<\/jats:title>\n                  <jats:p>In the USA and many other countries, endoscopic surveillance of colorectal adenoma patients is now widely practised. However, the optimal frequency and mode of such surveillance are not yet established. The aim of this trial was to compare surveillance at one, two, or five year intervals using <jats:italic>either<\/jats:italic> flexible sigmoidoscopy or colonoscopy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec sec-type=\"methods\">\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Analysis of a randomised trial of flexible sigmoidoscopy and colonoscopy over one, two, or five years after stratification for \u201chigh\u201d or \u201clow\u201d risk of recurrent adenomas. The trial started in 1984.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>A total of 776 patients were stratified into \u201chigh\u201d (n=307) and \u201clow\u201d (n=469) recurrence risk groups and randomised to flexible sigmoidoscopy or colonoscopy at varying intervals. Only 81 recurrent adenomas (30\/81 were &gt;1 cm in diameter) were detected in the 2307 person years of follow up within the surveillance study. Adenoma recurrence was significantly higher in the high risk group (relative rate 1.82; 95% confidence interval 1.2\u20132.9) but recurrence rates per 1000 person years were low and not significantly different in those surveyed by colonoscopy or flexible sigmoidoscopy. Loss to follow up was greatest in those having an annual examination compared with two or five yearly surveillance examinations. Despite surveillance, invasive cancer developed in four patients compared with an expected value of 9.12 for the general population in England (p=0.10); of these four patients who developed cancers, only one was detected by surveillance examination.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Adenoma recurrence rates were much lower than expected in both high and low risk groups. This suggests that endoscopic surveillance should be targeted at high risk groups. A surveillance interval of five years was as effective as shorter intervals in terms of cancer prevention, and was associated with similar compliance to two yearly examinations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/gut.49.1.91","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T06:37:59Z","timestamp":1027751879000},"page":"91-96","source":"Crossref","is-referenced-by-count":46,"title":["Risks, costs, and compliance limit colorectal adenoma surveillance: lessons from a randomised trial"],"prefix":"10.1136","volume":"49","author":[{"given":"J N","family":"Lund","sequence":"first","affiliation":[{"name":"aDivision of GI Surgery, University Hospital, Nottingham, UK, \n\nbDivision of Public Health and Epidemiology, University Hospital, Nottingham, UK, \n\ncTrent Institute for Health Services Research, University Hospital, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J H","family":"Scholefield","sequence":"additional","affiliation":[{"name":"aDivision of GI Surgery, University Hospital, Nottingham, UK, \n\nbDivision of Public Health and Epidemiology, University Hospital, Nottingham, UK, \n\ncTrent Institute for Health Services Research, University Hospital, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M J","family":"Grainge","sequence":"additional","affiliation":[{"name":"aDivision of GI Surgery, University Hospital, Nottingham, UK, \n\nbDivision of Public Health and Epidemiology, University Hospital, Nottingham, UK, \n\ncTrent Institute for Health Services Research, University Hospital, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S J","family":"Smith","sequence":"additional","affiliation":[{"name":"aDivision of GI Surgery, University Hospital, Nottingham, UK, \n\nbDivision of Public Health and Epidemiology, University Hospital, Nottingham, UK, \n\ncTrent Institute for Health Services Research, University Hospital, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Mangham","sequence":"additional","affiliation":[{"name":"aDivision of GI Surgery, University Hospital, Nottingham, UK, \n\nbDivision of Public Health and Epidemiology, University Hospital, Nottingham, UK, \n\ncTrent Institute for Health Services Research, University Hospital, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N C","family":"Armitage","sequence":"additional","affiliation":[{"name":"aDivision of GI Surgery, University Hospital, Nottingham, UK, \n\nbDivision of Public Health and Epidemiology, University Hospital, Nottingham, UK, \n\ncTrent Institute for Health Services Research, University Hospital, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M H","family":"Robinson","sequence":"additional","affiliation":[{"name":"aDivision of GI Surgery, University Hospital, Nottingham, UK, \n\nbDivision of Public Health and Epidemiology, University Hospital, Nottingham, UK, \n\ncTrent Institute for Health Services Research, University Hospital, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R F A","family":"Logan","sequence":"additional","affiliation":[{"name":"aDivision of GI Surgery, University Hospital, Nottingham, UK, \n\nbDivision of Public Health and Epidemiology, University Hospital, Nottingham, UK, \n\ncTrent Institute for Health Services Research, University Hospital, Nottingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2001,7,1]]},"reference":[{"key":"2025090714145111000_49.1.91.1","first-page":"327","article-title":"The adenoma-carcinoma sequence in cancer of the colon.","volume":"93","author":"Jackman","year":"1951","journal-title":"Surg Gynaecol Obstet"},{"key":"2025090714145111000_49.1.91.2","first-page":"451","article-title":"The polyp-cancer sequence in the large bowel.","volume":"67","author":"Morson","year":"1974","journal-title":"Proc R Soc Med"},{"key":"2025090714145111000_49.1.91.3","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1056\/NEJM199312303292701","article-title":"Prevention of colorectal cancer by colonoscopic polypectomy.","volume":"328","author":"Winawer","year":"1993","journal-title":"N Engl J Med"},{"key":"2025090714145111000_49.1.91.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199203053261002"},{"key":"2025090714145111000_49.1.91.5","doi-asserted-by":"publisher","DOI":"10.3109\/00365529509096314"},{"key":"2025090714145111000_49.1.91.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199203053261001"},{"key":"2025090714145111000_49.1.91.7","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/84.20.1572"},{"key":"2025090714145111000_49.1.91.8","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1995.00430160065007"},{"key":"2025090714145111000_49.1.91.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(98)70359-2"},{"key":"2025090714145111000_49.1.91.10","first-page":"A1122","article-title":"A prospective colonoscopic follow up study of 500 adenoma patients with multivariate analysis to predict risk of subsequent colorectal adenomas.","volume":"82","author":"Macrae","year":"1982","journal-title":"Gastroenterology"},{"key":"2025090714145111000_49.1.91.11","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1055\/s-2007-1021585","article-title":"Surveillance intervals after colonoscopic polypectomy.","volume":"14","author":"Waye","year":"1982","journal-title":"Endoscopy"},{"key":"2025090714145111000_49.1.91.12","first-page":"A67","article-title":"Follow-up colonoscopy after polypectomy.","volume":"26","author":"Fowler","year":"1980","journal-title":"Gastrointest Endosc"},{"key":"2025090714145111000_49.1.91.13","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/0016-5085(95)90066-7","article-title":"Incidence and recurrence rates of colorectal adenomas: a prospective study.","volume":"108","author":"Neugut","year":"1995","journal-title":"Gastroenterology"},{"key":"2025090714145111000_49.1.91.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(97)70214-2"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.49.1.91","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T21:14:59Z","timestamp":1757279699000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.49.1.91"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2001,7,1]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2001,7,1]]},"published-print":{"date-parts":[[2001,7,1]]}},"alternative-id":["10.1136\/gut.49.1.91"],"URL":"https:\/\/doi.org\/10.1136\/gut.49.1.91","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"type":"print","value":"0017-5749"},{"type":"electronic","value":"1468-3288"}],"subject":[],"published":{"date-parts":[[2001,7,1]]}}}