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Surveillance colonoscopy in low-risk postpolypectomy patients: Is it necessary?
  1. Thomas A Hornung1,
  2. Roisin Bevan2,
  3. Saqib Mumtaz3,
  4. Benjamin R Hornung4,
  5. Matthew D Rutter5
  1. 1Northern Region Endoscopy Group, University Hospital of North Tees, Stockton-on-Tees, UK
  2. 2Northern Region Endoscopy Group, South Tyneside NHS Foundation Trust, South Shields, Tyne and Wear, UK
  3. 3Leeds Centre for Digestive Disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
  5. 5Northern Region Endoscopy Group, University Hospital of North Tees, Durham University, Stockton-on-Tees, UK
  1. Correspondence to Dr Thomas A Hornung, Northern Region Endoscopy Group, University Hospital of North Tees, Stockton-on-Tees, UK; thomas_hornung{at}hotmail.co.uk

Abstract

Aim Patients who have had colorectal adenomas removed are at increased risk of developing colorectal cancer in the future. We sought to determine whether surveillance colonoscopy at 5 years in low-risk postpolypectomy patients is necessary and effective.

Method UK multicentre retrospective study. Patients diagnosed with ‘low-risk’ colorectal adenomas between April 2004 and April 2007 were identified and results of all subsequent lower gastrointestinal (GI) endoscopies were noted. Where no colonoscopy had been done at or after 5 years from the index investigation, patient details were cross-checked against hospital colorectal multidisciplinary team databases to ensure no colorectal cancer had been detected in the meantime.

Results 641 patients were included. 131 patients (20.4%) had a ‘per protocol’ surveillance colonoscopy at 5 years. Of these, no patients were found to have colorectal cancer, 10 patients (7.6%) had advanced adenomas, 26 patients (19.8%) had non-advanced adenomas and 95 patients (72.5%) had no further adenomas. 510 patients (79.6%) did not have a surveillance colonoscopy at 5 years. Of these, 110 patients (17.2%) developed lower GI symptoms within 5 years of their index endoscopy and underwent a further lower GI endoscopy to investigate these symptoms. 3 colorectal cancers in 3 patients were found during these endoscopies and two further colorectal cancers were found at symptomatic colonoscopies at or after 5 years from index.

Conclusions Patients with low-risk adenomas should be risk profiled. Those with risk factors, such as two adenomas, male sex and advanced adenomas at index procedure should be offered 5-year surveillance colonoscopy.

  • ADENOMA
  • CANCER PREVENTION
  • COLONOSCOPY
  • COLONIC POLYPS
  • COLORECTAL CANCER SCREENING

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