Implementation of ESGE guidelines in a regional colorectal cancer screening program allows to significantly reduce the burden of post-polipectomy surveilance colonoscopies

Aims To evaluate the potential impact of updating the post-polypectomy endoscopic surveillance recommendations of the colorectal cancer (CRC) screening program in a regional setting, using the 2020 ESGE guideline as a reference.

Methods Retrospective analysis of a prospective cohort of patients who underwent colonoscopy as part of the CRC screening program at a community hospital between October 2019 and June 2023. The follow-up strategy recommended by our regional screening program was compared to that outlined in the 2020 ESGE guideline [1].

Results After excluding CRC cases (23), 594 patients who underwent complete colonoscopy with adequate bowel preparation were included. According to our screening program guidelines, 40.9% (243) of patients were assigned to endoscopic surveillance. When applying the European guideline, this percentage was reduced to 32.2% (191). Of those assigned to surveillance, 21.4% (52) no longer required it, and 35.8% (87) had their surveillance interval extended from 1 year to 3 years for the first control colonoscopy. In 6.6% (16) of cases, the interval was shortened from 1 year to 3-6 months. Only 36.2% (88) of patients had no changes to the recommended surveillance strategy. The change in the criterion for≥3 to≥5 lesions needed to require surveillance was responsible for 69.2% of cases where surveillance colonoscopy would no longer be recommended. The abandonment of villous histology as a criterion for advanced adenoma accounted for 23.1%, and in 7.7% of cases, both criteria would no longer be met.

Conclusions An update to the population-based CRC screening program, based on the recommendations of the ESGE guideline, could potentially reduce or eliminate the need for endoscopic surveillance in over half of the patients.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 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