Although there are established guidelines for first surveillance colonoscopy (FSC) after polypectomy, there is no consensus on second surveillance colonoscopy (SSC), especially in Asian countries. The study aimed to investigate the association of SSC findings with index total colonoscopy (TCS) and FSC results.
This was a single-center retrospective cohort study involving 1,928 consecutive Japanese patients who received three or more colonoscopies. High-risk findings were defined as advanced adenoma (size ≥10 mm, with villous histology or with high-grade dysplasia) or more than three adenomas, whereas the low-risk findings were defined as one to two non-advanced adenomas. On the basis of index TCS results, the patients were divided into the no adenoma (NA) (n = 888), low-risk (LR) (n = 476), and high-risk (HR) (n = 564) groups, respectively.
In the NA group, the rate of high-risk findings on SSC was significantly higher in the patients with high-risk or low-risk findings than in those with no adenoma on FSC (7.7%, 7.9%, and 2.2%, respectively, P < 0.05). In the LR and HR groups, significantly higher rates of high-risk SSC findings were found for patients with high-risk FSC findings than for those with low-risk or no adenoma FSC findings (LR group: 28.6%, 9.4%, and 5.9 %, respectively, P < 0.01; HR group: 34.5%, 18.8%, and 7.9%, respectively, P < 0.01).
Index TCS and especially FSC findings were predictive of SSC results. The study results may be useful for determining appropriate surveillance intervals in Asian countries.

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