The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations

Abstract

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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

“…The risk of CRC at surveillance was reported in three studies, all rated as having a low risk of bias,31 32 94 102 and again demonstrated consistent statistically significant associations between HGD at index and CRC incidence, although the number of events was very small. One of these studies reported the incidence of CRC as 3.1% (OR 2.09, 95% CI 1.29 to 3.37) 31 32 102. The two other studies reported an OR of 13.2 (95% CI 2.8 to 62.1) for incidence of CRC,94 and an OR of 1.61 (95% CI 1.07 to 2.42) for interval CRC 102…”

“…Tubulovillous/villous histology has never been included in previous UK post-polypectomy guidelines, due to the well documented lack of inter-observer agreement among histopathologists in the assessment of villous architecture 29 30. The GDG felt the inclusion of tubulovillous/villous histology in the guidelines was not justified, given the additional surveillance workload that would be generated; this view is supported by the recent large study by Atkin et al 31 32 of individuals undergoing surveillance for intermediate grade adenomas detected in the symptomatic service, where tubulovillous/villous histology was not a risk factor for long-term CRC risk.…”

“…There were fairly consistent positive associations of finding AA at surveillance, with generally low to moderate risk of bias. Five studies31 32 93–97 reported a statistically significantly increased odds of AA at first surveillance if high-grade dysplasia (HGD) was present at index colonoscopy. Atkin et al 31 32 reported an incidence of AA of 19.06% (OR 1.44, 95% CI 1.18 to 1.75), and Huang et al 95 reported an incidence of 27.7% (HR 1.61, 95% CI 1.07 to 2.42).…”

“…Five studies31 32 93–97 reported a statistically significantly increased odds of AA at first surveillance if high-grade dysplasia (HGD) was present at index colonoscopy. Atkin et al 31 32 reported an incidence of AA of 19.06% (OR 1.44, 95% CI 1.18 to 1.75), and Huang et al 95 reported an incidence of 27.7% (HR 1.61, 95% CI 1.07 to 2.42). ORs only were reported by Facciorusso et al 96 97 and Fairley et al ,94 respectively, as 4.25 (95% CI 2.11 to 7.5) and 4.3 (95% CI 2.2 to 8.4), and Van Enckevort et al 93 reported an HR of 1.73 (95% CI 1.13 to 2.64).…”

Faecal immunochemical tests versus colonoscopy for post-polypectomy surveillance: an accuracy, acceptability and economic study

“…Most intermediaterisk individuals undergoing surveillance colonoscopy will not have CRC or AAs. [100][101][102] Colonoscopy is an uncomfortable procedure that carries a small risk of serious adverse events. 33,103 Furthermore, colonoscopy is expensive and surveillance colonoscopy is putting a growing strain on already overburdened endoscopy services.…”