Determining the optimal surveillance interval after a colonoscopic polypectomy for the Korean population?

Abstract

Background/AimsWestern surveillance strategies cannot be directly adapted to the Korean population. The aim of this study was to estimate the risk of metachronous neoplasia and the optimal surveillance interval in the Korean population.MethodsClinical and pathological data from index colonoscopy performed between June 2006 and July 2008 and who had surveillance colonoscopies up to May 2015 were compared between low- and high-risk adenoma (LRA and HRA) groups. The 3- and 5-year cumulative risk of metachronous colorectal neoplasia in both groups were compared.ResultsAmong 895 eligible patients, surveillance colonoscopy was performed in 399 (44.6%). Most (83.3%) patients with LRA had a surveillance colonoscopy within 5 years and 70.2% of patients with HRA had a surveillance colonoscopy within 3 years. The cumulative risk of metachronous advanced adenoma was 3.2% within 5 years in the LRA group and only 1.7% within 3 years in the HRA group. The risk of metachronous neoplasia was similar between the surveillance interval of <5 and ≥5 years in the LRA group; however, it was slightly higher at surveillance interval of ≥3 than <3 years in the HRA group (9.4% vs. 2.4%). In multivariate analysis, age and the ≥3-year surveillance interval were significant independent risk factors for metachronous advanced adenoma (P=0.024 and P=0.030, respectively).ConclusionsPatients had a surveillance colonoscopy before the recommended guidelines despite a low risk of metachronous neoplasia. However, the risk of metachronous advanced adenoma was increased in elderly patients and those with a ≥3-year surveillance interval.

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

“…Facciorusso et al 96 97 reported a significantly increased risk with the presence of more than one AA at index (OR 3.22, 95% CI 2.19 to 5.39) and Jang et al 114 reported a statistically significant increase in the odds of AA at first surveillance with increasing number of adenomas at index. However, Atkin et al 31 32 reported no significant association for three or four adenomas versus one adenoma, and three further studies reported no significant associations for any comparisons 106 109 115…”

“…The findings were inconsistent. Seven studies, ranging in size from 47 to 11 944 patients, presented evidence relating to the risk of AA at first surveillance 31 32 95 106 109 113–115. Only one of these106 reported a statistically significant increased risk for proximal adenomas at index versus either non-advanced adenoma or no adenoma (AA vs non-AA at first surveillance: RR 1.58, 95% CI 1.11 to 2.25; AA vs no adenoma at first surveillance: RR 1.84, 95% CI 1.31 to 2.59).…”

“…Twenty studies, with generally a low risk of bias, presented evidence on the association between male sex and outcomes at first surveillance. Eleven studies presented evidence relating to AA31 32 95–97 102 106 109 114 115 119–122; of these, four studies presented evidence showing a statistically significant increased risk of AA at first surveillance if the patient was male 95 102 114 122…”

Impact of obesity and metabolic abnormalities on the risk of metachronous colorectal neoplasia after polypectomy in men

“…Screening colonoscopy and polypectomy are known to produce the most significant effects on reducing the incidence and mortality of colorectal cancer (CRC) . Patients who have one or more adenomas removed are at an increased risk for developing metachronous advanced adenomas or cancer, and thus, these patients are recommended to undergo follow‐up surveillance colonoscopy . Current guidelines regarding post‐polypectomy surveillance have introduced the concept of risk stratification on the basis of baseline adenoma characteristics .…”

“…1,2 Patients who have one or more adenomas removed are at an increased risk for developing metachronous advanced adenomas or cancer, and thus, these patients are recommended to undergo follow-up surveillance colonoscopy. [3][4][5][6] Current guidelines regarding post-polypectomy surveillance have introduced the concept of risk stratification on the basis of baseline adenoma characteristics. 3,5,6 These guidelines stratify adenomas into two risk groups and recommend a surveillance colonoscopy every 10 years in individuals without adenomas, every 5-10 years in patients with low-risk adenomas, and every 3 years in those with high-risk adenomas.…”