Randomized Comparison of Surveillance Intervals after Colonoscopic Removal of Newly Diagnosed Adenomatous Polyps

Abstract

Colonoscopy performed three years after colonoscopic removal of adenomatous polyps detects important colonic lesions as effectively as follow-up colonoscopy after both one and three years. An interval of at least three years is recommended before follow-up colonoscopy after both one and three years. An interval of at least three years is recommended before follow-up examination after colonoscopic removal of newly diagnosed adenomatous polyps. Adoption of this recommendation nationally should reduce the cost of post-polypectomy surveillance and screening.

S3-Leitlinie – Kolorektales Karzinom

“…oder hochgradiger intraepithelialer Neoplasie sollte die Kontrollkoloskopie aufgrund des erhöhten Risikos einer fortgeschrittenen Neoplasie nach 3 Jahren erfolgen. Grundlage für diese Empfehlung sind die Daten der National Polyp Study, in der eine Untersuchung nach 3 Jahren eine ähnliche Rate an fortgeschrittenen Neoplasien ergab wie nach 1 Jahr [611]. Patienten mit 5 oder mehr Adenomen haben ein deutlich erhöhtes Risiko für eine fortgeschrittene Neoplasie von 24,9 % in einer gepoolten Analyse [619], vor allem, wenn 1 der Adenome ≥ 10 mm ist [622].…”

National Polyp Study data: Evidence for regression of adenomas

“…6 All patients referred for colonoscopy or polypectomy between November 1980 and February 1990 in 7 participating centers who did not have a family or personal history of familial polyposis, inflammatory bowel disease, or a personal history of polypectomy or colorectal cancer were eligible for enrollment in the study. A total of 9,112 subjects referred for colonoscopy were candidates for the study.…”

“…The eligible but nonrandomized and the eligible randomized adenoma patients had similar characteristics. 6 All detected polyps were removed and a surveillance colonoscopy was offered to the randomized patients in arm A at 1, 3 and 6 years after initial colonoscopy and in arm B at 3 and 6 years after initial colonoscopy. If the colon was not cleared with high confidence at surveillance colonoscopy, the patient was scheduled for repeat colonoscopy.…”

“…Adenoma Յ 5 mm; 15% Adenoma size at initial polypectomy of all patients included in the National Polyp Study; see Table II Adenoma 6-9 mm; 28% Adenoma 10ϩ mm; 99% Cancer: 100% Sensitivity of initial and surveillance colonoscopic examination Adenoma Յ 5 mm; 80% Back-to-back colonoscopy studies 23-25 Adenoma 6-9 mm; 85% Adenoma 10ϩ mm; 95% Cancer; 95% Reach of initial and surveillance colonoscopic examination 100% National Polyp Study design 6 tion is considered to be of high confidence. Then in the model, it is assumed that all initial and surveillance colonoscopic examinations consist of one colonoscopy and that the reach of the colonoscopy is 100%, i.e., the complete bowel is visualized so that subsequently none of the patients need to undergo a second colonoscopy.…”

Age‐related vulnerabilities of older adults with colon adenomas

“…2 CRC arises from neoplastic adenomatous polyps, 5 the prevalence of which increases from 20% to 25% at age 50 years and to 50% percent by ages 75-80 years. 6 Research demonstrates that, although most CRC can be prevented by early endoscopic resection of colon adenomas, 5 patients who have polyps removed have a 30% likelihood of developing recurrent polyps, 7,8 and many do not undergo additional screening. 9 Because polyp risk increases with age, interventions among older adults to prevent recurrent polyps likely would reduce the absolute number of CRC diagnoses among those at highest risk for the disease.…”