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

Hassan, Cesare; Quintero, Enrique; Dumonceau, Jean‐Marc; Reguła, Jarosław; Brandão, Catarina; Chaussade, Stanislas; Dekker, Evelien; Dinis-Ribeiro, Mário; Ferlitsch, Monika; Gimeno–García, Antonio Z.; Hazewinkel, Yark; Jover, Rodrigo; Kalager, Mette; Løberg, Magnus; Pox, Christian; Rembacken, Björn; Lieberman, David A.

doi:10.1055/s-0033-1344548

Cited by 491 publications

(504 citation statements)

References 128 publications

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“…Finally, it is also important to note that, according to most current guidelines, with the use of an HD+i-SCAN colonoscope, in our study, a higher proportion of patients (although not statistically significant) would be classified as having high-risk-adenoma, in which the recommended post-polypectomy surveillance interval for an effective prevention of CRC is shortened to 3 years (30,31) (Table II and Fig. 2).…”

Section: Discussionmentioning

confidence: 54%

Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening

A¹,

Saperas²

2016

Rev Esp Enferm Dig

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Background and aim:The usefulness of high definition colonoscopy plus i-scan (HD+i-SCAN) for average-risk colorectal cancer screening has not been fully assessed. The detection rate of adenomas and other measurements such as the number of adenomas per colonoscopy and the flat adenoma detection rate have been recognized as markers of colonoscopy quality. The aim of the present study was to compare the diagnostic performance of an HD+i-SCAN with that of standard resolution white-light colonoscope.Methods: This is a retrospective analysis of a prospectively collected screening colonoscopy database. A comparative analysis of the diagnostic yield of an HD+i-SCAN or standard resolution colonoscopy for average-risk colorectal screening was conducted.Results: During the period of study, 155/163 (95.1%) patients met the inclusion criteria. The mean age was 56.9 years. Sixty of 155 (39%) colonoscopies were performed using a HD+i-SCAN. Adenoma-detection-rates during the withdrawal of the standard resolution versus HD+i-SCAN colonoscopies were 29.5% and 30% (p = n.s.). Adenoma/colonoscopy values for standard resolution versus HD+i-SCAN colonoscopies were 0.46 (SD = 0.9) and 0.72 (SD = 1.3) (p = n.s.). A greater number of flat adenomas were detected in the HD+i-SCAN group (6/60 vs. 2/95) (p < .05). Likewise, serrated adenomas/polyps per colonoscopy were also higher in the HD+i-SCAN group.Conclusions: A HD+i-SCAN colonoscopy increases the flat adenoma detection rate and serrated adenomas/polyps per colonoscopy compared to a standard colonoscopy in averagerisk screening population. HD+i-SCAN is a simple, available procedure that can be helpful, even for experienced providers. The performance of HD+i-SCAN and substantial prevalence of flat lesions in our average-risk screening cohort support its usefulness in improving the efficacy of screening colonoscopies.

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Section: Discussionmentioning

confidence: 54%

Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening

A¹,

Saperas²

2016

Rev Esp Enferm Dig

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“…Adenomas were defined as advanced when they were 10 mm or larger or had villous architecture, high-grade dysplasia, or intramucosal carcinoma, or when three or more adenomas were found. [1][2][3] Advanced adenomas at baseline were classified as intermediate risk or high risk according to the European Guidelines of Surveillance.…”

Section: Variablesmentioning

confidence: 99%

“…The indication for and timing of the colonoscopies are based on a risk estimation, and different guidelines recommend follow-up schedules depending on findings at baseline, specifically the size and number of adenomas. [1][2][3] However, the evidence supporting these recommendations is of low to moderate quality. 2 On the other hand, colonoscopy quality varies considerably among endoscopists, with important variations in fulfillment of quality indicators, such as adenoma detection rate (ADR) or adenomas per colonoscopy rate (APCR).…”

Section: Introductionmentioning

confidence: 99%

Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection‐surveillance paradox

Mangas-Sanjuán¹,

Zapater

Cubiella³

et al. 2018

UEG Journal

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Background: Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines. Objective: The aim of this study was to evaluate the effect on follow-up findings of different quality metrics of the endoscopist performing the baseline colonoscopy. Methods: This retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking. Results: A total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow-up (13.1% vs 4.0%; p ¼ 0.001). On univariate analysis, high-risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19-0.97) and ADR (HR 0.94; 95% CI 0.89-0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow-up (HR 0.94; 95% CI 0.89-0.99). Conclusions: Our results suggest that the risk of identifying advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy. Key summarySummarize the established knowledge on this subject . Surveillance after polyp excision is based on an estimation of risk of metachronous advanced neoplasia. . Surveillance recommendations are made depending on size, number and pathology of polyps found at baseline. . Quality of baseline colonoscopy could influence findings at follow-up.What are the significant and/or new findings of the study?. Having advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy. . Baseline adenoma detection rate remained the only quality-related independent risk factor for advanced neoplasia at follow-up.

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“…Several recent studies have suggested that basal colonoscopy findings stratify adenomas into low-or high-risk (i.e. adenoma ≥10 mm, villous adenoma, adenoma with high-grade dysplasia, or invasive cancer) groups for recurrent adenomas during surveillance colonoscopy (3,4). CRC arises from both genetic and environmental factors and their interaction.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of risk factors for the recurrence of colorectal polyps and colorectal cancer

Ateş¹,

Sıvrı²,

Kılıçkap³

2017

Turk J Med Sci

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Background/aim: Colorectal adenomatous polyps are precursors of colorectal cancer (CRC), which can be prevented with surveillance colonoscopy. This study aimed to assess risk factors for the recurrence of colorectal polyps and CRC following polypectomy. Materials and methods:In this single-center trial, a total of 510 patients who applied to the endoscopy unit of Hacettepe University Hospital for various reasons and who were diagnosed with at least one colorectal adenomatous polyp between 2000 and 2010 were retrospectively analyzed. Patients with colorectal adenomatous polyps or CRC recurrences were examined in terms of clinical and histological risk factors.Results: A total of 190 (37.1%) patients had surveillance colonoscopy. Among them, 127 (66.3%) were found to have polyp recurrence. Of the parameters defined for polyp recurrence, no association was found between the number of polyps (1-2, ≥3) (1-3, ≥4) in the first colonoscopy and diabetes mellitus, hypertension, hyperlipidemia, sex, family history of colon malignancy, smoking, alcohol usage, size of polyp (<10 mm, ≥10 mm), or advanced histologic type of polyp. The only significant difference was observed in patients who had left-sided colon polyps. In the basal colonoscopy, 130 patients had been diagnosed with CRC, and a significant correlation was found between the number of polyps (1, ≥2) and polyp size (≥10 mm), anemia, high sedimentation rate (>25), and CRC. In the first surveillance colonoscopy, CRC was detected in 12 patients. There was a significant correlation between the development of CRC and advanced histological type, anemia with high erythrocyte sedimentation rate, polyp size (<10 mm, ≥10 mm), and the number of polyps (<3, ≥3). Conclusion:Patients with left-sided colon polyps had a high risk of developing colorectal polyp recurrence. Moreover, the risk of developing CRC increased in patients who had advanced histology, a polyp larger than 10 mm, or more than three polyps.

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

Cited by 491 publications

References 128 publications

Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening

Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening

Importance of endoscopist quality metrics for findings at surveillance colonoscopy: The detection‐surveillance paradox

Evaluation of risk factors for the recurrence of colorectal polyps and colorectal cancer

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