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

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Title: Post-polypectomy surveillance interval and advanced neoplasia detection rates: a multicenter, retrospective cohort study
Authors: Cross, AJ
Robbins, EC
Pack, K
Stenson, I
Rutter, MD
Veitch, AM
Saunders, BP
Duffy, SW
Wooldrage, K
Item Type: Journal Article
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.
Issue Date: 11-Apr-2022
Date of Acceptance: 26-Feb-2022
URI: http://hdl.handle.net/10044/1/97716
DOI: 10.1055/a-1795-4673
ISSN: 0013-726X
Publisher: Thieme Gruppe
Journal / Book Title: Endoscopy
Copyright Statement: © 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/)
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Surgery
COLONOSCOPY
SOCIETY
RISK
GUIDELINES
REMOVAL
Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Surgery
COLONOSCOPY
SOCIETY
RISK
GUIDELINES
REMOVAL
1103 Clinical Sciences
Gastroenterology & Hepatology
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer
School of Public Health



This item is licensed under a Creative Commons License Creative Commons