Clin Endosc.  2022 Jul;55(4):489-495. 10.5946/ce.2022.097.

Post-polypectomy surveillance: the present and the future

• Sekiguchi M
• Matsuda T
• Hotta K
• Saito Y

• KMID: 2531940
• DOI: http://doi.org/10.5946/ce.2022.097

Abstract

An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

Keyword

Colonoscopy; Colorectal cancer; Colorectal polyp; Polypectomy; Surveillance

Figure

• 

  Fig. 1. Proposal of risk-stratified post-polypectomy surveillance for individuals with adenomatous polyps in the new guidelines from the Japan Gastroenterological Endoscopy Society. Modified from Saito et al. Dig Endosc 2021;33:486–519.21

Reference

1. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012; 366:687–696.

2. Atkin W, Wooldrage K, Brenner A, et al. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. Lancet Oncol. 2017; 18:823–834.

3. Tran AH, Man Ngor EW, Wu BU. Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA Intern Med. 2014; 174:1675–1682.

4. Sekiguchi M, Igarashi A, Sakamoto T, et al. Cost-effectiveness analysis of postpolypectomy colonoscopy surveillance using Japanese data. Dig Endosc. 2019; 31:40–50.

5. Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. Gastroenterology. 2006; 130:1872–1885.

6. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012; 143:844–857.

7. Gupta S, Lieberman D, Anderson JC, et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2020; 158:1131–1153.

8. Hassan C, Quintero E, Dumonceau JM, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2013; 45:842–851.

9. Hassan C, Antonelli G, Dumonceau JM, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Update 2020. Endoscopy. 2020; 52:687–700.

10. Brenner H, Altenhofen L, Kretschmann J, et al. Trends in adenoma detection rates during the first 10 years of the German screening colonoscopy program. Gastroenterology. 2015; 149:356–366.

11. East JE, Atkin WS, Bateman AC, et al. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum. Gut. 2017; 66:1181–1196.

12. Shaukat A, Holub J, Greenwald D, et al. Variation over time and factors associated with detection rates of sessile serrated lesion across the united states: results form a national sample using the GIQuIC Registry. Am J Gastroenterol. 2021; 116:95–99.

13. Click B, Pinsky PF, Hickey T, et al. Association of colonoscopy adenoma findings with long-term colorectal cancer incidence. JAMA. 2018; 319:2021–2031.

14. He X, Hang D, Wu K, et al. Long-term risk of colorectal cancer after removal of conventional adenomas and serrated polyps. Gastroenterology. 2020; 158:852–861.

15. Lee JK, Jensen CD, Levin TR, et al. Long-term risk of colorectal cancer and related death after adenoma removal in a large, community-based population. Gastroenterology. 2020; 158:884–894.

16. Wieszczy P, Kaminski MF, Franczyk R, et al. Colorectal cancer incidence and mortality after removal of adenomas during screening colonoscopies. Gastroenterology. 2020; 158:875–883.

17. Sekiguchi M, Kakugawa Y, Matsumoto M, et al. Prevalence of serrated lesions, risk factors, and their association with synchronous advanced colorectal neoplasia in asymptomatic screened individuals. J Gastroenterol Hepatol. 2020; 35:1938–1944.

18. Foss FA, Milkins S, McGregor AH. Inter-observer variability in the histological assessment of colorectal polyps detected through the NHS Bowel Cancer Screening Programme. Histopathology. 2012; 61:47–52.

19. Matsuda T, Fujii T, Sano Y, et al. Randomised comparison of postpolypectomy surveillance intervals following a two-round baseline colonoscopy: the Japan Polyp Study Workgroup. Gut. 2020; 70:1469–1478.

20. Tanaka S, Saitoh Y, Matsuda T, et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol. 2015; 50:252–260.

21. Saito Y, Oka S, Kawamura T, et al. Colonoscopy screening and surveillance guidelines. Dig Endosc. 2021; 33:486–519.

22. Hotta K, Matsuda T, Tanaka K. Post-polypectomy colonoscopy surveillance in the real clinical practice: nationwide survey of 792 board certified institutions of the Japan Gastroenterological Endoscopy Society. Dig Endosc. 2020; 32:824.

23. Sekiguchi M, Otake Y, Kakugawa Y, et al. Incidence of advanced colorectal neoplasia in individuals with untreated diminutive colorectal adenomas diagnosed by magnifying image-enhanced endoscopy. Am J Gastroenterol. 2019; 114:964–973.

24. Djinbachian R, Dubé AJ, Durand M, et al. Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis. Endoscopy. 2019; 51:673–683.

25. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015; 81:31–53.

26. Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy. 2017; 49:378–397.

27. Sekiguchi M, Kakugawa Y, Matsumoto M, et al. A scoring model for predicting advanced colorectal neoplasia in a screened population of asymptomatic Japanese individuals. J Gastroenterol. 2018; 53:1109–1119.

28. Kamba S, Tamai N, Saitoh I, et al. Reducing adenoma miss rate of colonoscopy assisted by artificial intelligence: a multicenter randomized controlled trial. J Gastroenterol. 2021; 56:746–757.

29. Bishay K, Causada-Calo N, Scaffidi MA, et al. Associations between endoscopist feedback and improvements in colonoscopy quality indicators: a systematic review and meta-analysis. Gastrointest Endosc. 2020; 92:1030–1040.

30. Saito Y, Kodashima S, Matsuda T, et al. Current status of diagnostic and therapeutic colonoscopy in Japan: the Japan Endoscopic Database Project. Dig Endosc. 2022; 34:144–152.