Can a high-quality screening colonoscopy decrease the need for subsequent surveillance colonoscopies?

Abstract

Colorectal cancer (CRC) is the third most common cancer worldwide, with 2 million new cases diagnosed in 2020 and approximately one million deaths yearly [1]. Moreover, the International Agency for Research on Cancer estimates that by 2040, the global burden of CRC will have increased by 56 %, reaching 3 million new cases per year [1]. Screening and surveillance colonoscopies, which allow for polyp detection and removal, are critical in lowering CRC incidence. However, surveillance examinations account for up to 40 % of all colonoscopies, and incorrect surveillance accounts for one-third of the workload in CRC screening programs [2,3]. As a result, updated surveillance recommendations that optimize colonoscopy services without harming patients should be considered. Although the ideal strategy is currently unknown, ongoing investigations are evaluating potential criteria to determine which patients benefit the most from surveillance and the appropriate time frame between subsequent colonoscopies [4].In this issue of Endoscopy, we follow with great interest a retrospective national cohort study from Bonnington et al. [5]. The authors aimed to delineate the aforementioned criteria, by: 1) determining the surveillance yield for CRC and advanced adenoma; 2) identifying the possible predictors for surveillance outcome; and 3) comparing surveillance cohorts with the general population in terms of CRC rates."... individuals with a single adenoma ≥ 10 mm had a low likelihood of having additional adenomas found on surveillance follow-up (6.1 %). Hence, it is possible that this group could avoid surveillance by colonoscopy, especially as it represents almost one-third of all surveillance cases."In total, 44 151 individuals from the English Bowel Cancer Screening Programme underwent post-polypectomy surveillance between 2006 and 2017 [5]. The participants ranged in age from 60 to 74 years and were predominantly male (70.5 %). A similar number of patients were classified into intermediate-Can a high-quality screening colonoscopy decrease the need for subsequent surveillance colonoscopies?Referring to Bonnington SN et al.