Intermediate‐risk patients with three to four small adenomas should be considered low risk for colorectal cancer screening

Pérez-Cuadrado-Robles, Enrique; Torrella-Cortés, Emilio; Bebia-Conesa, Paloma; Quesada-Vázquez, Noé; Rodrigo-Agudo, José Luis; Chacón-Martínez, Silvia; López-Martín, Aurelio; Esteban-Delgado, Pilar; Pérez-Cuadrado-Martínez, Enrique; Pérez-Riquelme, Francisco

doi:10.1111/den.12570

Cited by 7 publications

(3 citation statements)

References 16 publications

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“…23 A cohort study of 561 individuals with 3-4 adenomas <10 mm suggested that the risk for metachronous advanced neoplasia among individuals with 3-4 adenomas was <5%. 33 This study was limited by the absence of a comparison group with only 1-2 nonadvanced adenomas. In a cohort study of 443 individuals with 1-9 adenomas <10 mm, no group with <10-mm polyps (including those with between 5 and 9 adenomas) had a rate of metachronous advanced neoplasia >10% on follow-up that extended up to 32 months.…”

Section: Recommended Post-colonoscopy Surveillance Strategies For Reducing Colorectal Cancer Riskmentioning

confidence: 99%

Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

et al. 2020

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C olonoscopy is performed routinely for colorectal cancer (CRC) screening, follow-up of other abnormal screening tests, workup of signs and symptoms of gastrointestinal disease, and surveillance after CRC and polyp removal. Post procedure, colonoscopists are expected to provide followup recommendations to patients and referring physicians. Recommendations for follow-up after normal colonoscopy among individuals age-eligible for screening, and postpolypectomy among all individuals with polyps are among the most common clinical scenarios requiring guidance. 1 Risk of metachronous advanced neoplasia is associated with findings on prior colonoscopy. After high-quality colonoscopy, patients with no neoplasia detected are at the lowest risk, and those with polyps are risk-stratified based on the histology, number, location, and size of polyps detected. Since the release of the last US Multi-Society Task Force (Task Force) recommendations for post-colonoscopy follow-up and polyp surveillance in 2012, 2 a number of articles have been published on risk of CRC based on colonoscopy findings and patient characteristics, as well as the potential impact of screening and surveillance colonoscopy on outcomes, such as incident CRC and polyps. Further, recent studies increasingly reflect the modern era of colonoscopy with more awareness of the importance of quality factors (eg, adequate bowel preparation, cecal intubation, adequate adenoma detection, and complete polyp resection), and utilization of state of the art technologies (eg, high-definition colonoscopes). Higher-quality colonoscopy could impact the importance of previously identified risk factors. Our aim was to review newly available evidence and update recommendations for follow-up after colonoscopy with or without polypectomy. Methods Evidence Review and Recommendation DevelopmentTo identify issues of greatest importance for the current revision, we developed PICO (patient, intervention, comparison, and outcome) questions (Supplementary Appendix A [SG and DL, with input from TK]). In consultation with a certified medical librarian (KH), literature searches were performed in PubMed, Embase, and CINAHL with a combination of controlled vocabulary and keyword terms for colonoscopy, polyps, and polypectomy surveillance (see Supplementary Appendix B for search terms). English-language articles since January 1, 2012 were retrieved. Searches were run on March 30, 2017, and identified a total of 1904 unique articles (see Supplementary Appendix C for article selection flow).Criteria used for inclusion/exclusion of titles, abstracts, and articles are outlined in Table 1. All titles were reviewed by a single author (SG) and potentially relevant titles were selected for abstract review. All abstracts were reviewed by 2 authors (SG and DL) and potentially relevant abstracts were selected for full article review. Included articles were reviewed in detail by the same 2 authors. The final list of articles selected for review was supplemented by repeating the literature search through S...

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Section: Recommended Post-colonoscopy Surveillance Strategies For Reducing Colorectal Cancer Riskmentioning

confidence: 99%

Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

et al. 2020

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“…Patients who had both ACRN and ASP were classified into the ACRN group. Patients were also classified into four groups according to the total number of colon polyps: 1–2, 3–4, 5–9, and 10 or more, referring to previous studies [ 6 , 7 ]. Non-neoplastic polyps, such as inflammatory polyps, were not considered in this study.…”

Section: Methodsmentioning

confidence: 99%

Total polyp number may be more important than size and histology of polyps for prediction of metachronous high-risk colorectal neoplasms

et al. 2022

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Background To evaluate whether the risk of metachronous high-risk colorectal neoplasm (HR-CRN) differs according to the indication for surveillance colonoscopy. Methods Patients who underwent polypectomy or endoscopic resection of colorectal neoplasms were enrolled and classified into three groups according to the indication for surveillance colonoscopy: advanced colorectal neoplasm (ACRN: adenoma ≥ 10 mm, adenoma with high-degree dysplasia and/or villous component), advanced serrated polyps (ASP: hyperplastic polyp or sessile serrated lesion ≥ 10 mm, traditional serrated polyp), and high-risk polyps (HRP: 3 or more adenomas or serrated polyps). The primary outcome was the development of metachronous HR-CRN, defined as ACRN, ASP, or HRP at the first follow-up colonoscopy. Results In total, 367 patients were enrolled (ACRN group: N = 264; ASP group: N = 33; HRP group: N = 70). Among the 160 patients who underwent follow-up colonoscopy, 28 (18%) had HR-CRN. In univariable analysis, indication for surveillance colonoscopy was not found to be associated with the development of metachronous HR-CRN. Instead, the total polyp number at index colonoscopy showed a positive association with the risk of metachronous HR-CRN in trend analysis (p = 0.001). In multivariable analysis, the presence of 5 or more polyps at index colonoscopy was found to be associated with the risk of metachronous HR-CRN (OR, 2.575, p = 0.049) after adjusting for risk factors, such as obesity, diabetes, and smoking. Conclusions The risk of metachronous HR-CRN did not differ according to the main indications for surveillance colonoscopy. The presence of 5 or more polyps at index colonoscopy was the only risk factor for metachronous HR-CRN.

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“…Although initial follow-ups were rather narrow 4 , in recent years, there has been a trend toward widen surveillance intervals 5 . Recent data show that some patients considered by the European guidelines for quality assurance in CRC 6 to be at high risk of advanced neoplasia during surveillance have the same outcomes as those at intermediate risk 7 and that some patients considered to be at intermediate risk may have outcomes similar to those at low risk 8 . The recently published European Society of Gastrointestinal Endoscopy (ESGE) guidelines address this new evidence and recommend not performing endoscopic surveillance in patients with complete excision of up to four adenomas < 10 mm regardless of the presence of a villous component.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background: 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 3-4 adenomas < 10 mm or an adenoma with villous histology as low risk. Aims: 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: Retrospective evaluation of a prospectively maintained fecal immunochemical test (FIT)-based regional CRC 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 attending the 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 3-4 adenomas as low risk. The proportion of patients from the “3-year surveillance” group who moved to the “no-surveillance” group was lower when an 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. Conclusion: 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.

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Intermediate‐risk patients with three to four small adenomas should be considered low risk for colorectal cancer screening

Abstract: Intermediate-risk patients with three to four small adenomas achieved a very low advanced lesion rate at follow up. Surveillance interval should be lengthened because these patients should be considered low risk.

Cited by 7 publications

References 16 publications

Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

Total polyp number may be more important than size and histology of polyps for prediction of metachronous high-risk colorectal neoplasms

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

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