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CC BY 4.0 · Endoscopy 2022; 54(10): 948-958
DOI: 10.1055/a-1795-4673
Original article

Post-polypectomy surveillance interval and advanced neoplasia detection rates: a multicenter, retrospective cohort study

Amanda J. Cross 
1   Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
,
Emma C. Robbins
1   Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
,
Kevin Pack
1   Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
,
Iain Stenson
1   Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
,
Matthew D. Rutter 
2   Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom
3   Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
,
Andrew M. Veitch
4   Department of Gastroenterology, New Cross Hospital, Wolverhampton, United Kingdom
,
Brian P. Saunders
5   Wolfson Unit for Endoscopy, St Mark’s Hospital, London, United Kingdom
,
Stephen W. Duffy
6   Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, United Kingdom
,
Kate Wooldrage
1   Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
› Author AffiliationsSupported by: Health Technology Assessment Programme 15/80/13
Supported by: Cancer Research UK C53889/A25004

Trial Registration: The All Adenomas study Registration number (trial ID): ISRCTN15213649 Type of study: Retrospective cohort study
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Referred to by:

Post-polypectomy surveillance: walking in the fogEndoscopy 2022; 54(10): 959-960
DOI: 10.1055/a-1849-2294

Referred to by:

Author commentary on Amanda J. Cross et al.Endoscopy 2022; 54(10): v31-v31
DOI: 10.1055/a-1778-9685

Abstract

Background Longer post-polypectomy surveillance intervals are associated with increased colorectal neoplasia detection at surveillance in some studies. We investigated this association to inform optimal surveillance intervals.

Methods Patients who underwent colonoscopy and post-polypectomy surveillance at 17 UK hospitals were classified as low/high risk by baseline findings. We compared detection rates of advanced adenomas (≥ 10 mm, tubulovillous/villous, high grade dysplasia), high risk findings (HRFs: ≥ 2 serrated polyps/[adenomas] of which ≥ 1 is ≥ 10 mm or has [high grade] dysplasia; ≥ 5 serrated polyps/adenomas; or ≥ 1 nonpedunculated polyp ≥ 20 mm), or colorectal cancer (CRC) at surveillance colonoscopy by surveillance interval (< 18 months, 2, 3, 4, 5, 6 years). Risk ratios (RRs) were estimated using multivariable regression.

Results Of 11 214 patients, 7216 (64 %) were low risk and 3998 (36 %) were high risk. Among low risk patients, advanced adenoma, HRF, and CRC detection rates at first surveillance were 7.8 %, 3.7 %, and 1.1 %, respectively. Advanced adenoma detection increased with increasing surveillance interval, reaching 9.8 % with a 6-year interval (P trend < 0.001). Among high risk patients, advanced adenoma, HRF, and CRC detection rates at first surveillance were 15.3 %, 10.0 %, and 1.5 %, respectively. Advanced adenoma and CRC detection rates (P trends < 0.001) increased with increasing surveillance interval; RRs (95 % confidence intervals) for CRC were 1.54 (0.68–3.48), 4.44 (1.95–10.08), and 5.80 (2.51–13.40) with 3-, 4-, and 5-year intervals, respectively, versus an interval of < 18 months.

Conclusions Metachronous neoplasia was uncommon among low risk patients, even with long surveillance intervals, supporting recommendations for no surveillance in these patients. For high risk patients, a 3-year surveillance interval would ensure timely CRC detection.

Supplementary material



Publication History

Received: 05 February 2021

Accepted after revision: 26 January 2022

Article published online:
11 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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