Intermediate-risk patients with three to four small adenomas should be considered low risk for colorectal cancer screening

Background and Aim Intermediate‐risk patients following a colorectal cancer screening program may have differential risk of advanced lesions depending on the findings of an index colonoscopy. The aim of the present study was to comparatively assess advanced colorectal neoplasia risk at the first follow‐up colonoscopy among the different intermediate‐risk subgroups with a focus on patients with three to four adenomas. Methods All patients recruited for a baseline screening colonoscopy between 2006 and 2011 were included. Number, size and histopathological characteristics of adenomas were collected. Main outcome was an advanced colorectal neoplasia detection rate (invasive carcinoma or advanced adenoma) at the first follow‐up colonoscopy. Low‐ and high‐risk patients were excluded. Results Five hundred and sixty‐one intermediate‐risk patients (63.3% men, mean age: 59.01 ± 6.16 years) underwent indexing and follow‐up colonoscopy. By multivariate analysis, three to four adenomas (OR: 3.613 [95% CI: 1.661–7.859], P = 0.001) and adenoma size ≥10