Impact of the European Society of Gastrointestinal Endoscopy 2020 guidelines on the number of scheduled post-polypectomy surveillance colonoscopies

Abstract

Background and study aims In contrast with the European Society of Gastrointestinal Endoscopy (ESGE) 2013 and the US Multi-society Task Force (USMSTF) 2020 guidelines, the ESGE 2020 guideline considers patients with three to four adenomas < 10 mm or an adenoma with villous histology as low risk. The aim of this study was to quantify the influence of the application of the new ESGE 2020 guidelines, as opposed to the ESGE 2013 and USMSTF 2020 guidelines, on the number of scheduled colonoscopies, and to describe the main causes for changes in the surveillance intervals.

Patients and methods A retrospective evaluation was conducted of a prospectively maintained fecal immunochemical test (FIT)-based regional colorectal cancer screening program database. Surveillance regimens following ESGE 2020, ESGE 2013, and USMSTF 2020 guidelines were compared.

Results Overall, 1284 individuals with a positive FIT and undergoing colonoscopy were consecutively included. When applying the ESGE 2020 guidelines, 10.8 % of patients changed to a “no-surveillance” group (relative reduction in colonoscopies of 82.5 %). The main reason for these changes was considering three to four adenomas as low risk. The proportion of patients from the “3-year surveillance” group who moved to the “no-surveillance” group was lower when a sessile serrated lesion (SSL) was present (ESGE 2013, 32.0% vs 16.3 %; USMSTF 2020 17.2 % vs 6.8 %). Analyzing the 41 patients with SSLs who remained unchanged in the “no-surveillance” group, only in 15 (36.6 %) the cause was the presence of an SSL.

Conclusions applying the new ESGE 2020 guidelines could reduce by 11 % the proportion of individuals being offered surveillance. SLLs have not a major influence on the change of surveillance intervals.

• References

• 1 Joseph DA, Meester RG, Zauber AG. et al. Colorectal cancer screening: Estimated future colonoscopy need and current volume and capacity. Cancer 2016; 122: 2479-2486
• 2 Cardoso R, Niedermaier T, Chen C. et al. Colonoscopy and sigmoidoscopy use among the average-risk population for colorectal cancer: a systematic review and trend analysis. Cancer Prev Res (Phila) 2019; 12: 617-630
• 3 Calderwood AH, Holub JL, Greenwald DA. et al. Yield and practice patterns of surveillance colonoscopy among older adults: an analysis of the GI Quality Improvement Consortium. Am J Gastroenterol 2019; 114: 1811-1819
• 4 Cairns SR, Scholefield JH, Steele RJ. et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59: 666-689
• 5 Jover R, Bretthauer M, Dekker E. et al. Rationale and design of the European Polyp Surveillance (EPoS) trials. Endoscopy 2016; 48: 571-578
• 6 Atkin WS, Valori R, Kuipers EJ. et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition – Colonoscopic surveillance following adenoma removal. Endoscopy 2012; 44: SE151-SE163
• 7 Cubiella J, Carballo F, Portillo I. et al. Incidence of advanced neoplasia during surveillance in high- and intermediate-risk groups of the European colorectal cancer screening guidelines. Endoscopy 2016; 48: 995-1002
• 8 Perez-Cuadrado-Robles E, Torrella-Cortes E, Bebia-Conesa P. et al. Intermediate-risk patients with three to four small adenomas should be considered low risk for colorectal cancer screening. Digest Endosc 2016; 28: 450-455
• 9 Hassan C, Antonelli G, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020. Endoscopy 2020; 52: 687-700
• 10 Click B, Pinsky PF, Hickey T. et al. Association of Colonoscopy Adenoma Findings With Long-term Colorectal Cancer Incidence. JAMA 2018; 319: 2021-2031
• 11 Cubiella J, Castro I, Hernandez V. et al. Characteristics of adenomas detected by fecal immunochemical test in colorectal cancer screening. Cancer Epidemiol Biomarkers Prev 2014; 23: 1884-1892
• 12 Hassan C, Quintero E, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851
• 13 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 91: 463-485 e465
• 14 Bleijenberg A, Klotz D, Loberg M. et al. Implications of different guidelines for surveillance after serrated polyp resection in United States of America and Europe. Endoscopy 2019; 51: 750-758
• 15 Beso Delgado M, Ibanez Cabanell J, Perez Sanz E. et al. Results of 10 years of the Colorectal Cancer Prevention Program in the Valencian Community. Rev Esp Salud Publica 2021; 95: e202107100
• 16 Ahadi M, Sokolova A, Brown I. et al. The 2019 World Health Organization Classification of appendiceal, colorectal and anal canal tumours: an update and critical assessment. Pathology 2021; 53: 454-461
• 17 Bustamante-Balen M, Satorres C, Ramos-Soler D. et al. Evaluation of the optical criteria for sessile serrated lesions of the colon: A prospective study on a colorectal cancer screening population. Endosc Int Open 2021; 9: E14-E21
• 18 Lue A, Hijos G, Sostres C. et al. The combination of quantitative faecal occult blood test and faecal calprotectin is a cost-effective strategy to avoid colonoscopies in symptomatic patients without relevant pathology. Therap Adv Gastroenterol 2020; 13
• 19 Loughrey MB, Ings G, Dickey W. et al. Evaluating the impact of 2020 post-polypectomy surveillance guidelines in the Northern Ireland bowel cancer screening programme. Gut 2021; 70: 226-228
• 20 Rouphael C, Lopez R, McMichael J. et al. ≥ 3 Nonadvanced adenomas are more common in the era of contemporary colonoscopy and not associated with metachronous advanced neoplasia. J Clin Gastroenterol 2021; 55: 343-349
• 21 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
• 22 Jover R, Herraiz M, Alarcon O. et al. Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy 2012; 44: 444-451
• 23 Anderson JC, Butterly LF, Weiss JE. et al. Providing data for serrated polyp detection rate benchmarks: an analysis of the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2017; 85: 1188-1194
• 24 Waldmann E, Kammerlander A, Gessl I. et al. New risk stratification after colorectal polypectomy reduces burden of surveillance without increasing mortality. United Europ Gastroenterol J 2021;
• 25 Zorzi M, Hassan C, Capodaglio G. et al. Long-term performance of colorectal cancerscreening programmes based on the faecal immunochemical test. Gut 2018; 67: 2124-2130