Post-polypectomy colonoscopy surveillance: Can we improve the diagnostic yield?

Ibáñez‐Sanz, Gemma; Sanz‐Pamplona, Rebeca; Garcia, Montse

doi:10.1016/j.gastrohep.2021.11.005

Cited by 4 publications

(5 citation statements)

References 91 publications

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“…In Spain, there is a national CRC screening program that has increased the proportion of colonoscopies performed, accounting for 30% of the examinations in our endoscopy unit. The second most common indication is postpolypectomy surveillance, which is in line with other Spanish endoscopy units and is partly a consequence of CRC screening [17]. Subjects in screening populations frequently have few comorbidities and high rates of adequate bowel cleansing [18].…”

Section: Discussionmentioning

confidence: 80%

Comparative Study of Predictive Models for the Detection of Patients at High Risk of Inadequate Colonic Cleansing

Gimeno-García,

Sacramento-Luis,

Cámara-Suárez

et al. 2024

JPM

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Background: Various predictive models have been published to identify outpatients with inadequate colonic cleansing who may benefit from intensified preparations to improve colonoscopy quality. The main objective of this study was to compare the accuracy of three predictive models for identifying poor bowel preparation in outpatients undergoing colonoscopy. Methods: This cross-sectional study included patients scheduled for outpatient colonoscopy over a 3-month period. We evaluated and compared three predictive models (Models 1–3). The quality of colonic cleansing was assessed using the Boston Bowel Preparation Scale. We calculated the area under the curve (AUC) and the corresponding 95% confidence interval for each model. Additionally, we performed simple and multiple logistic regression analyses to identify variables associated with inadequate colonic cleansing and developed a new model. Results: A total of 649 consecutive patients were included in the study, of whom 84.3% had adequate colonic cleansing quality. The AUCs of Model 1 (AUC = 0.67, 95% CI [0.63–0.70]) and Model 2 (AUC = 0.62, 95% CI [0.58–0.66]) were significantly higher than that of Model 3 (AUC = 0.54, 95% CI [0.50–0.58]; p < 0.001). Moreover, Model 1 outperformed Model 2 (p = 0.013). However, the new model did not demonstrate improved accuracy compared to the older models (AUC = 0.671). Conclusions: Among the three compared models, Model 1 showed the highest accuracy for predicting poor bowel preparation in outpatients undergoing colonoscopy and could be useful in clinical practice to decrease the percentage of inadequately prepared patients.

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Section: Discussionmentioning

confidence: 80%

Comparative Study of Predictive Models for the Detection of Patients at High Risk of Inadequate Colonic Cleansing

Gimeno-García,

Sacramento-Luis,

Cámara-Suárez

et al. 2024

JPM

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“…In addition, the USMSTF further stratify serrated polyps (SPs) based on their histologic subtypes: hyperplastic polyps (HPs), sessile serrated polyps (SSPs), and traditional serrated adenomas (TSAs). [1][2][3] While the ESGE considers all SPs with dysplasia or that are > 1 cm including HPs as high risk lesions with a 3 year follow up recommendation, the USMSTF classifies only SSP > 1 cm or with dysplasia, 5-10 SSPs < 1 cm and TSAs as high risk requiring a 3 year follow up, and recommends a 3-5 year interval for large (> 1 cm) HPs. In addition, the USMSTF has 4 additional risk groups with various recommended intervals for SSPs or tubular adenomas < 1 cm.…”

Section: Introductionmentioning

confidence: 99%

“…Although both guidelines recommend a 3-year surveillance interval for adenomas that are large (≥ 1 cm) or multiple (≥ 5) or have high grade dysplasia (HGD), only the USMSTF considers villous/tubulovillous adenomas, regardless of size, as high risk lesions, requiring a 3-year follow-up. In addition, the USMSTF further stratifies serrated polyps based on their histologic subtypes: hyperplastic polyps (HPPs), sessile serrated polyps (SSPs), and traditional serrated adenomas (TSAs) [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Using New Hampshire Colonoscopy Registry data to assess United States and European post-polypectomy surveillance guidelines

et al. 2022

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Background and Study Aims: Our goal was to compare the updated European Society of Gastrointestinal Endoscopy (ESGE) and United States Multi-Society Task Force on Colorectal Cancer (USMSTF) high risk groups in predicting metachronous advanced neoplasia on first follow-up colonoscopy and long term colorectal cancer (CRC). Patients and Methods: We compared advanced metachronous neoplasia risk (serrated polyps (SPs) (>/=1 cm or with dysplasia), advanced adenomas ((>/=1 cm, villous, HGD), CRC) on first surveillance colonoscopy in patients with ESGE versus the USMSTF high risk findings. In addition, we compared the positive and negative predictive values (PPV/NPV) of both guidelines for metachronous neoplasia. Results: The risk for metachronous neoplasia in our sample (n=20,458) was higher in the high risk USMSTF (3 year) (13.6%; 95% CI: 12.3-14.9) and ESGE groups (13.6%;95% CI:12.3-15.0) as compared to the lowest risk USMSTF (5.1%;95%CI:4.7-5.5;p<0.001) and ESGE categories (6.3%;95%CI:4.7-5.5;6.0-6.7p<0.001) respectively. Adding other groups such as USMSTF 5-10 and 3-5 year groups to the 3 year category resulted in minimal change in the PPV/NPVs for metachronous advanced neoplasia. High risk ESGE (HR:3.03,95%CI:1.97-4.65) and USMSTF (HR:3.07,95%CI:2.03-4.66) designations were associated with similar long term CRC risk (CRC per 100,000 person-years : USMSTF 3 year group :3.54;95%CI:2.68-4.68 and ESGE high risk group: 3.43; 95%CI:2.57-4.59). Conclusion: Performance characteristics for the ESGE and USMSTF recommendations are similar in predicting metachronous advanced neoplasia and long term CRC. Furthermore, the addition of risk groups such as the USMSTF 5-10/3-5 year groups to the USMSTF 3 year category did not alter the PPV or NPV significantly.

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“…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 %).…”

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confidence: 99%

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confidence: 99%

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

Pawlak

2023

Endoscopy

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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.

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Post-polypectomy colonoscopy surveillance: Can we improve the diagnostic yield?

Cited by 4 publications

References 91 publications

Comparative Study of Predictive Models for the Detection of Patients at High Risk of Inadequate Colonic Cleansing

Comparative Study of Predictive Models for the Detection of Patients at High Risk of Inadequate Colonic Cleansing

Using New Hampshire Colonoscopy Registry data to assess United States and European post-polypectomy surveillance guidelines

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

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