Endoscopic surveillance after colonic polyps and colorrectal cancer resection. 2018 update

Mangas-Sanjuán, Carolina; Jover, Rodrigo; Cubiella, Joaquín; Marzo-Castillejo, Mercè; Balaguer, Francesc; Bessa, Xavier; Bujanda, Luís; Bustamante, Marco; Castells, Antoni; Díaz-Tasende, José; Díez-Redondo, Pilar; Herráiz, Maite; Mascort-Roca, Juan José; Pellisé, M.; Quintero, Enrique

doi:10.1016/j.gastre.2019.02.014

Cited by 9 publications

(14 citation statements)

References 87 publications

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“…Subjects are kept under surveillance in the screening programs in Spain until 75 years. Furthermore, the available practice guidelines recommend surveillance in patients between 75 and 80 years old only if they maintain an excellent performance status with minimum comorbidity [ 9 , 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…A low-risk group is defined when 1–2 adenomas are detected (<10 mm, tubular histology and low-grade dysplasia). On the contrary, a high-risk group is defined when at least one advanced adenoma (≥10 mm, villous histology and high grade displasia) or one serrated lesion (≥10 mm and displasia) is detected [ 8 , 9 , 10 ]. Clinical practice guidelines (CPG) have taken these characteristics into account when determining surveillance recommendations and intervals [ 3 , 8 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…On the contrary, a high-risk group is defined when at least one advanced adenoma (≥10 mm, villous histology and high grade displasia) or one serrated lesion (≥10 mm and displasia) is detected [ 8 , 9 , 10 ]. Clinical practice guidelines (CPG) have taken these characteristics into account when determining surveillance recommendations and intervals [ 3 , 8 , 9 , 10 ]. Patients with low-risk lesions have been routinely recommended to return to population screening programs, whereas patients with high-risk lesions are recommended to perform endoscopic surveillance with different intervals between explorations [ 9 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Polyprev: Randomized, Multicenter, Controlled Trial Comparing Fecal Immunochemical Test with Endoscopic Surveillance after Advanced Adenoma Resection in Colorectal Cancer Screening Programs: A Study Protocol

et al. 2021

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Colorectal cancer (CRC) screening programs have been implemented to reduce the burden of the disease. When an advanced colonic lesion is detected, clinical practice guidelines recommend endoscopic surveillance with different intervals between explorations. Endoscopic surveillance is producing a considerable increase in the number of colonoscopies, with a limited effect on the CRC incidence. Instead, participation in CRC screening programs based on the fecal immunochemical test (FIT) could be a non-inferior alternative to endoscopic surveillance to reduce 10-year CRC incidence. Based on this hypothesis, we have designed a multicenter and randomized clinical trial within the Spanish population CRC screening programs to compare FIT surveillance with endoscopic surveillance. We will include individuals aged from 50 to 65 years with complete colonoscopy and advanced lesions resected within the CRC screening programs. Patients will be randomly allocated to perform an annual FIT and colonoscopy if fecal hemoglobin concentration is ≥10 µg/g, or to perform endoscopic surveillance. On the basis of the non-superior CRC incidence, we will recruit 1894 patients in each arm. The main endpoint is 10-year CRC incidence and the secondary endpoints are diagnostic yield, participation, adverse effects, mortality and cost-effectiveness. Our results may modify the clinical practice after advanced colonic resection in CRC screening programs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Polyprev: Randomized, Multicenter, Controlled Trial Comparing Fecal Immunochemical Test with Endoscopic Surveillance after Advanced Adenoma Resection in Colorectal Cancer Screening Programs: A Study Protocol

et al. 2021

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“…Our study has several limitations, mostly related to its retrospective nature. We are lacking uniformity in the histological evaluation among centers and there are several relevant variables that are lacking, mainly tumor budding and the depth of invasion using the Kikuchi scale [ 18 , 21 , 22 , 23 , 24 , 25 , 32 ]. This last is the most relevant as long as there is a direct relation between submucosa depth of invasion and the risk of residual disease and lymph node involvement.…”

Section: Discussionmentioning

confidence: 99%

pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease

Cubiella

González

Almazán

et al. 2020

Cancers

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The aim of this study is to describe the treatment of pT1 colorectal cancer (CRC) in a mass screening program, the surgery-related complications and the factors associated with residual disease after endoscopic resection and extraluminal disease after surgery. We included in this retrospective analysis all the pT1 CRC detected in the Galician CRC screening program between May 2013 and June 2019. We determined which variables were independently associated with the outcomes of the study through a multivariable logistic regression analysis. We included 370–354 pT1 N0(X), 16 pT1N1- out of the 971 CRC detected; 277 (74.9%) were resected endoscopically and 162 (43.8%) were not referred to surgery. There were surgical complications in 30.7% and 16.3% of the patients during hospitalization and after discharge. Residual disease was detected in 12 (4.3%) after endoscopic resection and extraluminal disease in 18 (8.6%) patients after surgery. The variables independently associated with initial endoscopic resection were a pedunculated morphology (OR 33.1, 95% CI 4.3–254), a diameter ≥ 20 mm (OR 3.94, 95% CI 1.39–11.18) and a Site–Morphology–Size–Access score < 9 (OR 428, 95% CI 42–4263). The variables related with surgery rescue were a piecemeal resection (OR 4.48, 95% CI 1.48–13.6), an infiltrated/nonevaluable resection border (OR 7.44, 95% CI 2.12–26.0), a non-well-differentiated histology (OR 4.76, 95% CI 1.07–20.0), vascular infiltration (OR 8.24, 95% CI 2.72–25.0) and a Haggitt 4 infiltration of the submucosa (OR 5.68, 95% CI 2.62–12.3). Residual disease after endoscopic resection was associated with an infiltrated/nonevaluable resection border (OR 34.9, 95% CI 4.08–298), a non-well-differentiated histology (OR 6.67, 95% CI 1.05–50.0), and the vascular infiltration of the submucosa (OR 7.61, 95% CI 1.55–37.4). The variables related with extraluminal disease after surgical resection were no endoscopic resection (OR 4.34, 95% CI 1.26–14.28), a non-well-differentiated histology (OR 4.35, 95% CI 1.39–14.29) and the lymphatic infiltration of the submucosa (OR 4.8, 95% CI 1.32–17.8). In a CRC screening program, although most of pT1 CRC are candidates for endoscopic treatment, surgery is a safe procedure. We have defined some easy to evaluate variables that can be used in the decision-making process.

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“…Additionally, using current guidelines for surveillance after screening colonoscopy [15,16], we classified patients by the recommended surveillance interval (3 or 10 years) based on the findings of the index colonoscopy and by the recommended interval based on the findings after both the index and repeat colonoscopies.…”

Section: Outcome Definitionsmentioning

confidence: 99%

Diagnostic yield of early repeat colonoscopy after suboptimal bowel preparation in a fecal immunochemical test-based screening program

et al. 2020

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Background Current guidelines regarding surveillance after screening colonoscopy assume adequate bowel preparation. However, follow-up intervals after suboptimal cleansing are highly heterogeneous. We aimed to determine the diagnostic yield of early repeat colonoscopy in patients with suboptimal bowel preparation in fecal immunochemical test (FIT)-based screening colonoscopy. Methods An observational study including patients who underwent colonoscopy with suboptimal bowel preparation after positive FIT screening and then repeat colonoscopy within 1 year. Suboptimal preparation was defined as a Boston Bowel Preparation Scale (BBPS) score of 1 in any segment. Patients with a BBPS score of 0 in any segment or incomplete examination were excluded. The adenoma detection rate (ADR), advanced ADR (AADR), and colorectal cancer rate were calculated for the index and repeat colonoscopies. Results Of the 2474 patients with FIT-positive colonoscopy at our center during this period, 314 (12.7 %) had suboptimal preparation. Of the 259 (82.5 %) patients who underwent repeat colonoscopy, suboptimal cleansing persisted in 22 (9 %). On repeat colonoscopy, the ADR was 38.7 % (95 %CI 32.6 % to 44.8 %) and the AADR was 14.9 % (95 %CI 10.5 % to 19.4 %). The per-adenoma miss rate was 27.7 % (95 %CI 24.0 % to 31.6 %), and the per-advanced adenoma miss rate was 17.6 % (95 %CI 13.3 % to 22.7 %). After repeat colonoscopy, the post-polypectomy surveillance recommendation changed from 10 to 3 years in 14.7 % of the patients with previous 10-year surveillance recommendation. Conclusions Patients with suboptimal bowel preparation on FIT-positive colonoscopy present a high rate of advanced adenomas in repeat colonoscopy, with major changes in post-polypectomy surveillance recommendations.

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Endoscopic surveillance after colonic polyps and colorrectal cancer resection. 2018 update

Cited by 9 publications

References 87 publications

Polyprev: Randomized, Multicenter, Controlled Trial Comparing Fecal Immunochemical Test with Endoscopic Surveillance after Advanced Adenoma Resection in Colorectal Cancer Screening Programs: A Study Protocol

Polyprev: Randomized, Multicenter, Controlled Trial Comparing Fecal Immunochemical Test with Endoscopic Surveillance after Advanced Adenoma Resection in Colorectal Cancer Screening Programs: A Study Protocol

pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease

Diagnostic yield of early repeat colonoscopy after suboptimal bowel preparation in a fecal immunochemical test-based screening program

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