Implications of different guidelines for surveillance after serrated polyp resection in United States of America and Europe

Arne Bleijenberg; Dagmar Klotz; Magnus Løberg; Evelien Dekker; Hans Olov Adami; Ernst J. Kuipers; Øyvind Holme; Mette Kalager; Louise Emilsson; Britta Kleist; Leif Løvdal; Jaroslaw Regula; Else M. Løberg; Joep IJspeert; Michael Bretthauer

doi:10.1055/a-0916-8598

Endoscopy, Inhaltsverzeichnis

Endoscopy 2019; 51(08): 750-758
DOI: 10.1055/a-0916-8598

Original article

Implications of different guidelines for surveillance after serrated polyp resection in United States of America and Europe

Arne Bleijenberg

¹Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands

,

Dagmar Klotz

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

³Departments of Pathology and Transplantation Medicine, Oslo University Hospital, Oslo, Norway

,

Magnus Løberg

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

³Departments of Pathology and Transplantation Medicine, Oslo University Hospital, Oslo, Norway

,

Evelien Dekker

¹Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands

,

Hans Olov Adami

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

⁴Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden

,

Ernst J. Kuipers

⁵Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands

,

Øyvind Holme

⁶University of Oslo and Cancer Registry of Norway, Oslo, and Sorlandet Hospital Trust, Kristiansand, Norway

,

Mette Kalager

⁷Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

,

Louise Emilsson

⁷Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

⁸Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Norway

,

Britta Kleist

⁹Department of Pathology, Soerlandet Sykehus HF, Kristiansand, Norway

,

Leif Løvdal

⁹Department of Pathology, Soerlandet Sykehus HF, Kristiansand, Norway

,

Jaroslaw Regula

¹⁰Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland

¹¹Department of Oncological Gastroenterology, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland

,

Else M. Løberg

¹²Department of Pathology, Oslo University Hospital, Ullevål, Oslo, Norway

,

Joep IJspeert

¹Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands

,

Michael Bretthauer

²Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

³Departments of Pathology and Transplantation Medicine, Oslo University Hospital, Oslo, Norway

› Institutsangaben

Abstract

Introduction Because individuals with serrated polyps and adenomas are at increased risk of developing new polyps and colorectal cancer (CRC), surveillance after resection is justified. After adenoma resection, most international guidelines are consistent, but recommendations for surveillance after serrated polyp resection vary. The United States Multi-Society Taskforce on CRC (US-MSTF) base surveillance intervals on serrated polyp subtype (traditional serrated adenoma, sessile serrated polyp, hyperplastic polyps), while the European Society of Gastrointestinal Endoscopy (ESGE) guidelines do not take serrated polyp subtype into account. We evaluated the implications of this difference in a primary colonoscopy screening cohort.

Methods We included participants from a large colonoscopy screening trial. In a post-hoc simulation, assuming full protocol adherence, we determined the surveillance interval for each subject based on their polyp burden, using the most recent US-MSTF and ESGE guidelines.

Results We included 5323 participants, of whom 1228 had one or more serrated polyps. In 5201 of all participants (98 %; Cohen’s kappa 0.90) and in 1106 of those with serrated polyps (90 %; Cohen’s kappa 0.80), both guidelines recommended identical surveillance intervals. Recommendations for a 3-year surveillance interval were identical between the two guidelines. All 122 subjects with discordant recommendations would receive a follow-up colonoscopy after 10 years using ESGE guidance and after 5 years using US-MSTF guidance.

Conclusion Despite the different criteria used to determine surveillance after serrated polyp resection, most individuals are recommended identical colonoscopy surveillance intervals whether following the ESGE or US-MSTF guidelines. This suggests that surveillance recommendations do not need to consider the serrated polyp subtype.

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