The 2020 United Kingdom (UK) post-polypectomy surveillance guidelines accurately classify post-polypectomy patients by those at high risk for colorectal cancer (CRC) and for whom one surveillance colonoscopy appears appropriate, as well as those at low risk who can be managed by non-invasive screening, according to a study published in Gut.

Post-polypectomy surveillance aims to prevent CRC or detect it early following the removal of premalignant polyps (PMPs). In 2020, the UK, European Union (EU), and United States (US) surveillance guidelines were updated to incorporate new data on

long-term CRC incidence and mortality. The accuracy of the classification criteria and the appropriateness of the surveillance recommendations in the new UK guidelines have not been investigated. Therefore, researchers examined guideline appropriateness by performing a retrospective analysis of patients who underwent colonoscopy and polypectomy from 2000-2010 at 17 UK hospitals, followed-up through 2017.


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The researchers found that among 21,318 patients, 368 CRCs occurred during follow-up (median, 10.1 years). Baseline CRC risk factors included age ≥55 years, ≥2 PMPs, adenomas with tubulovillous/villous/unknown histology or high-grade dysplasia, proximal polyps, and a baseline visit spanning 2–90 days.

Compared with the general population, CRC incidence without surveillance was higher among those with adenomas with high-grade dysplasia or ≥2 PMPs, of which ≥1 was advanced. For low-risk (71%) and high-risk (29%) patients, standardized incidence ratios (SIRs) without surveillance were 0.75 and 1.30, respectively. For high-risk patients after first surveillance, the SIR was 1.22.

“Healthcare professionals can be reassured that the new UK guidelines accurately identify patients at increased risk after polypectomy, and that a one-off surveillance colonoscopy is appropriate for these patients,” stated the authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

Cross AJ, Robbins EC, Pack K, et al. Colorectal cancer risk following polypectomy in a multicentre, retrospective, cohort study: an evaluation of the 2020 UK post-polypectomy surveillance guidelines. Gut. Published online March 5, 2021. doi: 10.1136/gutjnl-2020-323411