Adenoma size, not just count, shaped later advanced neoplasia risk

The edition in brief

A cohort of 16,870 adults aged 50 to 75 with repeat colonoscopies found five-year advanced colorectal neoplasia rose with the number of non-advanced adenomas, from 1.3% with none to 4.0% with one or two, 5.3% with three or four and 10.1% with five to ten. Within each count group, having at least one 6–9 mm adenoma raised risk compared with diminutive adenomas only, for example 8.1% against 3.0% with three or four. In 331 asymptomatic first-degree relatives of people with Crohn's disease, 19% had persistently raised faecal calprotectin; on capsule endoscopy or colonoscopy, 2.7% of those screened had changes compatible with presymptomatic Crohn's disease, and a calprotectin above 225 µg/g identified them well. A fifth of single raised results normalised on repeat. A Journal of Hepatology expert opinion notes that liver cancer surveillance rests on observational evidence without randomised trials, that most positive results are false positives in low-prevalence groups, and argues for risk-based surveillance using prediction models already applied in hepatitis B.