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Post-polypectomy surveillance interval and advanced neoplasia detection rates: A multicenter, retrospective cohort study

Lookup NU author(s): Professor Matt Rutter



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022 Georg Thieme Verlag. All rights reserved. Background Longer post-polypectomy surveillance intervals are associated with increased colorectal neoplasia detection at surveillance in some studies. We investigated this association to inform optimal surveillance intervals. Methods Patients who underwent colonoscopy and post-polypectomy surveillance at 17 UK hospitals were classified as low/high risk by baseline findings. We compared detection rates of advanced adenomas (≥ 10 mm, tubulovillous/villous, high grade dysplasia), high risk findings (HRFs: ≥ 2 serrated polyps/[adenomas] of which ≥ 1 is ≥ 10 mm or has [high grade] dysplasia; ≥ 5 serrated polyps/adenomas; or ≥ 1 nonpedunculated polyp ≥ 20 mm), or colorectal cancer (CRC) at surveillance colonoscopy by surveillance interval (< 18 months, 2, 3, 4, 5, 6 years). Risk ratios (RRs) were estimated using multivariable regression. Results Of 11214 patients, 7216 (64 %) were low risk and 3998 (36 %) were high risk. Among low risk patients, advanced adenoma, HRF, and CRC detection rates at first surveillance were 7.8 %, 3.7 %, and 1.1 %, respectively. Advanced adenoma detection increased with increasing surveillance interval, reaching 9.8 % with a 6-year interval (P trend < 0.001). Among high risk patients, advanced adenoma, HRF, and CRC detection rates at first surveillance were 15.3 %, 10.0 %, and 1.5 %, respectively. Advanced adenoma and CRC detection rates (P trends < 0.001) increased with increasing surveillance interval; RRs (95 % confidence intervals) for CRC were 1.54 (0.68-3.48), 4.44 (1.95-10.08), and 5.80 (2.51-13.40) with 3-, 4-, and 5-year intervals, respectively, versus an interval of < 18 months. Conclusions Metachronous neoplasia was uncommon among low risk patients, even with long surveillance intervals, supporting recommendations for no surveillance in these patients. For high risk patients, a 3-year surveillance interval would ensure timely CRC detection.

Publication metadata

Author(s): Cross AJ, Robbins EC, Pack K, Stenson I, Rutter MD, Veitch AM, Saunders BP, Duffy SW, Wooldrage K

Publication type: Article

Publication status: Published

Journal: Endoscopy

Year: 2022

Volume: 54

Issue: 10

Pages: 948-958

Online publication date: 11/04/2022

Acceptance date: 26/01/2022

Date deposited: 11/05/2022

ISSN (print): 0013-726X

ISSN (electronic): 1438-8812

Publisher: Georg Thieme Verlag


DOI: 10.1055/a-1795-4673

PubMed id: 35405762


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Funder referenceFunder name
Cancer Research UK | C53889/A25004
Health Technology Assessment Programme | 15/80/13