Implications of different guidelines for surveillance after serrated polyp resection in United States of America and Europe

Bleijenberg, Arne; Klotz, Dagmar; Løberg, Magnus; Dekker, Evelien; Adami, Hans Olov; Kuipers, Ernst J.; Holme, Øyvind; Kalager, Mette; Emilsson, Louise; Kleist, Britta; Løvdal, Leif; Reguła, Jarosław; Løberg, Else Marit; IJspeert, Joep E. G.; Bretthauer, Michael

doi:10.1055/a-0916-8598

Cited by 13 publications

(7 citation statements)

References 29 publications

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“…However, our results indicated a surveillance interval of approximately 3 years, regardless of the presence of SSL, and observed no significant difference in the risk of metachronous HRA/AA. Furthermore, a recent study reported that the serrated polyp subtype had a minimal effect on determining the surveillance interval 26 . Given these findings, it is reasonable to recommend a surveillance colonoscopy interval equal to that of the similar adenoma risk group, irrespective of the presence of synchronous SSL.…”

Section: Discussionmentioning

confidence: 99%

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Sessile serrated lesions in patients with adenoma on index colonoscopy do not increase metachronous advanced adenoma risk

Hong

Kim

Lee

et al. 2021

Digestive Endoscopy

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Objectives Post‐polypectomy surveillance intervals should be determined based on index colonoscopy findings. However, the risk of metachronous lesions, resulting from the coexistence of adenoma and sessile serrated lesions (SSLs), has rarely been addressed. We evaluated the impact of synchronous SSL on the risk of metachronous lesions within similar adenoma risk groups. Methods We retrieved individuals with one or more adenomas on index colonoscopy in a single‐center retrospective cohort and stratified them into four groups depending on the presence of SSL and low‐risk/high‐risk adenoma (LRA/HRA). Participants who underwent surveillance colonoscopies at least 12 months apart were included. We compared the risks of metachronous lesions including HRA, advanced adenoma (AA), or SSL within similar adenoma risk groups according to the presence of SSL. Results Overall 4493 individuals were included in the analysis. The risk of metachronous HRA/AA was not significantly higher in the adenoma with SSL group compared with the adenoma without SSL group, irrespective of LRA (HRA, 6/86 vs. 231/3297, P = 1.00; AA, 0/86 vs. 52/3297, P = 0.64) or HRA (HRA, 11/64 vs. 240/1046, P = 0.36; AA, 3/64 vs. 51/1046, P = 1.00). However, the risk of metachronous SSL in individuals with synchronous SSL was higher than that in those without SSL for both LRA (15/86 vs. 161/3297, P < 0.001) and HRA groups (11/64 vs. 61/1046, P = 0.002). Conclusion The presence of synchronous SSL did not increase the risk of metachronous HRA/AA, compared with isolated adenoma, but increased the risk of metachronous SSL.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, a recent study reported that the serrated polyp subtype had a minimal effect on determining the surveillance interval. 26 Given these findings, it is reasonable to recommend a surveillance colonoscopy interval equal to that of the similar adenoma risk group, irrespective of the presence of synchronous SSL.…”

Section: Discussionmentioning

confidence: 99%

Sessile serrated lesions in patients with adenoma on index colonoscopy do not increase metachronous advanced adenoma risk

Hong

Kim

Lee

et al. 2021

Digestive Endoscopy

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“…Because of the high interobserver variation in serrated polyp classification [74 -77], the risk of inaccurate histologic subclassification of serrated polyp is substantial and undesirable. In addition, a recent study demonstrated that the effect of taking into account serrated polyp subtype in surveillance guidelines is only marginal, and resulted in different surveillance intervals in only 2 % of screened patients compared to a surveillance guideline not taking into account the serrated polyp subtype [78]. Therefore, to prevent undertreatment due to misclassification of serrated polyps, we recommend not to consider the serrated polyp subtype when choosing colonoscopy surveillance intervals.…”

Section: Serrated Polyps In Patients Requiring Surveillancementioning

confidence: 99%

Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

et al. 2020

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Main RecommendationsThe following recommendations for post-polypectomy colonoscopic surveillance apply to all patients who had one or more polyps that were completely removed during a high quality baseline colonoscopy. 1 ESGE recommends that patients with complete removal of 1 – 4 < 10 mm adenomas with low grade dysplasia, irrespective of villous components, or any serrated polyp < 10 mm without dysplasia, do not require endoscopic surveillance and should be returned to screening.Strong recommendation, moderate quality evidence.If organized screening is not available, repetition of colonoscopy 10 years after the index procedure is recommended.Strong recommendation, moderate quality evidence. 2 ESGE recommends surveillance colonoscopy after 3 years for patients with complete removal of at least 1 adenoma ≥ 10 mm or with high grade dysplasia, or ≥ 5 adenomas, or any serrated polyp ≥ 10 mm or with dysplasia. Strong recommendation, moderate quality evidence. 3 ESGE recommends a 3 – 6-month early repeat colonoscopy following piecemeal endoscopic resection of polyps ≥ 20 mm.Strong recommendation, moderate quality evidence. A first surveillance colonoscopy 12 months after the repeat colonoscopy is recommended to detect late recurrence.Strong recommendation, high quality evidence. 4 If no polyps requiring surveillance are detected at the first surveillance colonoscopy, ESGE suggests to perform a second surveillance colonoscopy after 5 years. Weak recommendation, low quality evidence.After that, if no polyps requiring surveillance are detected, patients can be returned to screening. 5 ESGE suggests that, if polyps requiring surveillance are detected at first or subsequent surveillance examinations, surveillance colonoscopy may be performed at 3 years. Weak recommendation, low quality evidence.A flowchart showing the recommended surveillance intervals is provided (Fig. 1).

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“…This idea has been also shown by a study comparing the ESGE 2013 guideline 12 with the USMSTF 2012 21 focusing on the influence of serrated lesions. The assignment to the “3-year surveillance” group was the same regardless of the existence of SSLs because of the concurrence of advanced adenomas or three or more non-advanced adenomas 14 .…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, ESGE and USMSTF guidelines treat sessile serrated lesions (SSLs) differently, USMSTF guidelines considering specifically the number and size of SSLs 9 12 13 . These differences could have also an influence on surveillance intervals, but the evidence on the importance of SSLs in the planning of post-polypectomy follow-up is scarce 14 .…”

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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Implications of different guidelines for surveillance after serrated polyp resection in United States of America and Europe

Cited by 13 publications

References 29 publications

Sessile serrated lesions in patients with adenoma on index colonoscopy do not increase metachronous advanced adenoma risk

Sessile serrated lesions in patients with adenoma on index colonoscopy do not increase metachronous advanced adenoma risk

Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020

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

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