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TOPLINE:

A new study revealed that patients with high-risk findings at both baseline and first surveillance colonoscopy (SC1) had a significantly higher risk for colorectal cancer (CRC) than the general population, requiring a second surveillance visit. Conversely, those with low-risk findings at SC1 did not require a second surveillance visit, regardless of their baseline findings.

METHODOLOGY:

• Researchers analysed data of 10,508 patients who underwent colonoscopy with polypectomy at 17 UK hospitals from 1984 to 2010.
• Following the 2020 UK postpolypectomy surveillance guidelines, patients were classified into the following four groups on the basis of combinations of low-risk and high-risk findings at baseline and SC1: Low risk-low risk (LR-LR), high risk-low risk (HR-LR), low risk-high risk (LR-HR), and high risk-high risk (HR-HR). The first adenoma sighting was defined as "baseline."
• Overall, 6587 (63%) patients were in the LR-LR group, 3272 (31%) patients in the HR-LR group, 248 (2%) patients in the LR-HR group, and 401 (4%) patients in the HR-HR group.
• The primary outcome was incident CRC, with a median follow-up duration of 8 years from SC1. Researchers also compared the incidence of CRC with that in the general population using standardised incidence ratios (SIRs).

TAKEAWAY:

• After SC1, the cumulative incidence of CRC at 3 years was 0.2% in the LR-LR group, 0.5% in the HR-LR group, 1.7% in the HR-HR group, and not estimable in the LR-HR group.
• Compared with the general population, the incidence of CRC after SC1 was lower in the LR-LR group (SIR, 0.48), not significantly different in the HR-LR group (SIR, 1.17) or LR-HR group (SIR, 2.51), but higher in the HR-HR group (SIR, 2.84).
• After second surveillance, the incidence of CRC in the HR-HR group was no longer significantly different from that in the general population (SIR, 1.86).
• Detection rates of advanced premalignant polyps at second surveillance were 5.4%, 9.1%, 12.2%, and 17.4% in the LR-LR, HR-LR, LR-HR, and HR-HR groups, respectively.

IN PRACTICE:

"Patients with high-risk findings at both baseline and SC1 needed a second surveillance visit, while those with low-risk findings at SC1 did not, regardless of their baseline findings," the authors wrote. "Our data suggest that there may be limited value in classifying patients using both baseline and SC1 findings, and that classification using SC1 findings alone may be sufficient to inform recommendations for the second surveillance visit, although this warrants further research," they added.

SOURCE:

This study was led by Emma C. Robbins, Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, England. It was published online in Gut.

LIMITATIONS:

The observational and retrospective design limited data on endoscopist performance indicators, with bowel preparation quality data often missing. Researchers lacked complete data on reasons for follow-up visits, preventing the confirmation of whether visits were for surveillance, symptom investigation, or positive screening tests. The understanding, detection, and classification of serrated polyps were limited during the study period. Estimates of the incidence of CRC among patients compared with those among the general population might be underestimated due to the exclusion criteria that were not applied to the general population reference group.

DISCLOSURES:

This study received funding from the National Institute for Health and Care Research Health Technology Assessment programme and Cancer Research UK. One author who was the chief investigator received all the funding. The other authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.