Screening or Surveillance of Patients After Removal of Colorectal Adenomas?
Posted: Monday, May 4, 2020
The 2002 United Kingdom surveillance guidelines stratify patients with adenomas into low-, intermediate-, and high-risk patients for colorectal cancer, although there is limited supporting evidence for the recommended management strategies for each group. Amanda J. Cross, PhD, of Imperial College London, and colleagues suggested that although postpolypectomy surveillance reduces the risk of colorectal cancer, low- or intermediate-risk patients may be managed more effectively by routine screening rather than surveillance. The report, published in Gut, noted that long-term studies and economic evaluations are necessary to validate optimal surveillance strategies for those at risk of colorectal cancer.
The research team retrospectively evaluated almost 30,000 patients who underwent colonoscopy with adenoma removal between 2000 and 2010 in the United Kingdom. Individuals were classified as low- (n = 14,401), intermediate- (n = 11,852), and high-risk (n = 2,719) patients.
After a median follow-up of 9.3 years, the incidence of colorectal cancer per 100,000 person-years in the low-, intermediate-, and high-risk groups was 140, 221, and 366, respectively. The incidence of colorectal cancer was halved (40%–50%) in patients who had a single surveillance visit compared with none.
Colonoscopy surveillance significantly reduced the risk of colorectal cancer in high-risk patients, as well as intermediate-risk patients who had an incomplete colonoscopy, adenoma with high-grade dysplasia, or proximal polyps at baseline. Surveillance also reduced the risk of cancer among low- and intermediate-risk patients who underwent a complete baseline colonoscopy without high-grade dysplasia or proximal polyps. However, after a complete baseline colonoscopy and polypectomy, the risk in the low- and intermediate-risk groups did not significantly differ from that in the general population, suggesting routine screening may be a better management technique.
“Incorporating these findings into guidelines could reduce surveillance colonoscopies by a third, while ensuring that patients at increased risk are protected,” the researchers concluded.
Disclosure: For full disclosures of the study authors, visit gut.bmj.com.