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.