Post-Polypectomy Surveillance in the English Bowel Cancer Screening Programme: Results of First Surveillance

Bonnington, Stuart; Sharp, Linda; Rutter,

doi:10.1055/s-0039-1681511

Cited by 3 publications

(12 citation statements)

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“…Analysis of English BCSP surveillance data showed polyp size was not statistically significant for CRC detection on univariable analysis; however, it was statistically significant for AA yield at first surveillance on univariable analysis: OR 1 for largest adenoma of 10–14 mm; OR 1.28 for 20–29 mm (95% CI 1.171 to 1.401); OR 1.57 for 30–39 mm (95% CI 1.369 to 1.804); OR 2.10 for ≥40 mm (95% CI 1.817 to 2.431); and was statistically significant for AA at first surveillance on multivariable analysis: OR 1.38 for non-pedunculated adenoma of ≥10 mm compared with none (95% CI 1.288 to 1.483) 103–105…”

Section: Resultsmentioning

confidence: 83%

“…Adenoma multiplicity was also statistically significant for AA at first surveillance on univariable analysis (compared with one adenoma, OR 1.62 for two adenomas (95% CI 1.469 to 1.798); OR 1.61 for three adenomas (95% CI 1.457 to 1.783); OR 2.02 for four adenomas (95% CI 1.806 to 2.262); OR 2.38 for five adenomas (95% CI 2.113 to 2.696); OR 2.75 for 6–9 adenomas (95% CI 2.475 to 3.076); and OR 3.82 for ≥10 adenomas (95% CI 3.278 to 4.473)). It was also statistically significant for AA at first surveillance on multivariable analysis: OR 1.56 for two adenomas (95% CI 1.407 to 1.736); OR 1.58 for three adenomas (95% CI 1.424 to 1.753); OR 1.90 for four adenomas (95% CI 1.692 to 2.136); OR 2.23 for five adenomas (95% CI 1.973 to 2.538); OR 2.47 for 6–9 adenomas (95% CI 2.208 to 2.773); and OR 3.03 for ≥10 adenomas (95% CI 2.578 to 3.570) 103–105…”

Section: Resultsmentioning

confidence: 94%

“…Analysis of English BCSP surveillance data (n=43 131 for AA; n=28 468 for CRC) showed HGD was not significantly associated with subsequent diagnosis of CRC on univariable analysis. Moreover, although HGD was weakly associated with AA at first surveillance, this was not significant on multivariable analysis (OR 1.08, 95% CI 0.994 to 1.172) 103–105…”

Section: Resultsmentioning

confidence: 95%

“…Analysis of English BCSP surveillance data showed villous histology was not statistically significantly associated with subsequent CRC incidence at surveillance. However, it was statistically significant for AA at first surveillance on univariable analysis: OR 1.38 for TVA (95% CI 1.296 to 1.487), OR 1.89 for villous adenoma (VA) (95% CI 1.654 to 2.170); and on multivariable analysis: OR 1 for tubular adenoma only, OR 1.37 for TVA (95% CI 1.277 to 1.472), OR 1.69 for VA (95% CI 1.475 to 1.952) 103–105…”

Section: Resultsmentioning

confidence: 99%

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British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

Rutter

East

Rees

et al. 2019

Gut

245

376

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These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped?two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThe Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG’s guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThe key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); orfive or more premalignant polypsThis cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.

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Section: Resultsmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

Rutter

East

Rees

et al. 2019

Gut

245

376

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show abstract

“…A registry study stratified more than 40,000 patients as either high-risk (≥ 5 adenomas) or intermediate risk (3 to 4 small adenomas). High-and intermediate-risk patients had more advanced adenomas than patients with a single adenoma ≥ 10 mm (12.3 % and 8.0 % vs. 6.1 %) [20]. The only factor with an odds ratio > 2 for advanced adenomas was adenoma multiplicity [21].…”

Section: Conclusion Low-volume Ner1006 Enhances High-qualitymentioning

confidence: 93%

High-quality colon cleansing and multiple neoplasia detection with 1L NER1006 versus mid-volume options: Post hoc analysis of phase 3 clinical trials

Epstein¹,

Bénamouzig

Halonen

et al. 2020

Endosc Int Open

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Background and study aims Multiple neoplasia increase the risk of colorectal cancer. High-quality cleansing may improve adenoma detection. We assessed whether a new bowel preparation can improve colon cleansing and multiple lesion detection. Patients and methods This post hoc analysis of two randomized clinical trials in Europe and the US assessed the per study and combined cleansing efficacy of overnight split dosing with (preparation + clear fluids) 1 + 1 L polyethylene glycol (PEG) NER1006 versus 2 + 1 L PEG + ascorbate (2LPEG) or 1 + 2 L oral sulfate solution (OSS) combined. Treatment-blinded central readers assessed cleansing quality using the Harefield Cleansing Scale (HCS). Patients with full segmental scoring were included. HCS segmental scores 0–4 (high-quality = HCS 3–4) were analyzed for NER1006 versus 2LPEG/OSS. Mean number of polyps or adenomas per patient (MPP/MAP) was calculated for treatments in patients with at least one polyp or adenoma. Results In 1037 patients, NER1006 attained a greater rate of HCS 3 scores (29 % vs. 20 %; P < 0.001) and HCS 4 scores (20 % vs. 17 %; P = 0.007) versus 2LPEG/OSS. More polyps (678 versus 585) and adenomas (397 versus 331) were detected with NER1006 (N = 517) versus 2LPEG/OSS (N = 520). In all neoplasia-positive patients, with increasing minimal per-patient neoplasia multiplicity from 1 to 10, NER1006 numerically improved MPP (difference ± SE: 0.48 ± 0.24 to 3.89 ± 3.37) and MAP (0.47 ± 0.26 to 7.50 ± 9.00) versus 2LPEG/OSS. Conclusions Low-volume NER1006 enhances high-quality cleansing versus medium-volume 2LPEG or OSS, individually and when combined. NER1006 may consequently facilitate the detection of multiple neoplasia in patients.

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Improved detection of colorectal adenomas by high-quality colon cleansing

et al. 2020

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Background and study aims Reliable adenoma detection requires “adequate” bowel preparation. The adenoma detection rate (ADR) was assessed in patients with high-quality (stool-free) cleansing versus adequate cleansing. Patients and methods This study was a post-hoc combined analysis of three randomized trials individually powered for cleansing quality assessment. Treatment-independent ADR was assessed versus colon cleansing quality by central readers using the Harefield Cleansing Scale (HCS) and the Boston Bowel Preparation Scale (BBPS). The number needed to treat (NNT) to find an additional patient with at least one adenoma was calculated for high-quality versus adequate-quality cleansing. Results A total of 1749 patients were included. ADR increased with high-quality versus adequate-quality cleansing: HCS grade A versus B, 39 % (94/242) versus 27 % (336/1229); NNT = 8.7; P < 0.001. ADR also increased with high-quality versus uniform adequate segmental cleansing scores: HCS grade A versus uniform segmental scores 2, 39 % (94/242) versus 26 % (97/379); NNT = 7.5; P < 0.001. ADR increased with top-quality versus adequate segmental cleansing scores: HCS uniform segmental scores 4 versus 2, 54 % (21/39) versus 26 % (97/379); NNT = 3.6; P < 0.001. ADR increased with BBPS 9 versus 6, 43 % (71/166) versus 26 % (247/950); NNT = 6.0; P < 0.001. Right colon ADR increased with top-quality versus adequate cleansing: HCS 4 versus 2, 20 % (25/122) versus 11 % (121/1117); NNT = 10.4; P < 0.001 and BBPS 3 versus 2, 15 % (42/284) versus 11 % (130/1192); NNT = 25.8; P = 0.033. Conclusions High-quality colon cleansing improves adenoma detection, and it should be a priority for bowel preparations for colonoscopy.

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Post-Polypectomy Surveillance in the English Bowel Cancer Screening Programme: Results of First Surveillance

Cited by 3 publications

References 0 publications

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

High-quality colon cleansing and multiple neoplasia detection with 1L NER1006 versus mid-volume options: Post hoc analysis of phase 3 clinical trials

Improved detection of colorectal adenomas by high-quality colon cleansing

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