Colorectal cancer risk following polypectomy in a multicentre, retrospective, cohort study: an evaluation of the 2020 UK post-polypectomy surveillance guidelines

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Title: Colorectal cancer risk following polypectomy in a multicentre, retrospective, cohort study: an evaluation of the 2020 UK post-polypectomy surveillance guidelines
Authors: Cross, A
Robbins, E
Pack, K
Stenson, I
Patel, B
Rutter, M
Veitch, A
Saunders, B
Duffy, S
Wooldrage, K
Item Type: Journal Article
Abstract: Objective: Colonoscopy surveillance aims to reduce colorectal cancer (CRC) incidence post-polypectomy. The 2020 UK guidelines recommend surveillance at three years for ‘high-risk’ patients with ≥2 premalignant polyps (PMPs) of which ≥1 is ‘advanced’ (serrated polyp [or adenoma] ≥10mm or with [high-grade] dysplasia); ≥5 PMPs; or ≥1 non-pedunculated polyp ≥20mm; ‘low-risk’ patients without these findings are instead encouraged to participate in population-based CRC screening. We examined the appropriateness of these risk classification criteria and recommendations. Design: Retrospective analysis of patients who underwent colonoscopy and polypectomy mostly between 2000–2010 at 17 UK hospitals, followed-up through 2017. We examined CRC incidence by baseline characteristics, risk group, and number of surveillance visits using Cox regression, and compared incidence with that in the general population using standardised incidence ratios (SIRs). Results: Among 21,318 patients, 368 CRCs occurred during follow-up (median: 10.1 years). Baseline CRC risk factors included age ≥55 years, ≥2 PMPs, adenomas with tubulovillous/villous/unknown histology or high-grade dysplasia, proximal polyps, and a baseline visit spanning 2–90 days. Compared with the general population, CRC incidence without surveillance was higher among those with adenomas with high-grade dysplasia (SIR:1.74, 95%CI:1.21–2.42) or ≥2 PMPs of which ≥1 was advanced (1.39, 1.09–1.75). For low-risk (71%) and high-risk (29%) patients, SIRs without surveillance were 0.75 (95%CI:0.63–0.88) and 1.30 (1.03–1.62), respectively; for high-risk patients after first surveillance, the SIR was 1.22 (0.91–1.60). Conclusion: These guidelines accurately classify post-polypectomy patients into those at high-risk, for whom one surveillance colonoscopy appears appropriate, and those at low-risk who can be managed by non-invasive screening.
Issue Date: 8-Nov-2021
Date of Acceptance: 1-Jan-2021
DOI: 10.1136/gutjnl-2020-323411
ISSN: 0017-5749
Publisher: BMJ Publishing Group
Start Page: 2307
End Page: 2320
Journal / Book Title: Gut
Volume: 70
Issue: 12
Copyright Statement: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:
Sponsor/Funder: National Institute for Health Research
Cancer Research UK
Funder's Grant Number: 15/80/13
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
colorectal adenomas
colorectal cancer
colorectal cancer screening
Gastroenterology & Hepatology
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
Publication Status: Published
Online Publication Date: 2021-03-05
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
School of Public Health

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