Endoscopy 2019; 51(08): 750-758
DOI: 10.1055/a-0916-8598
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Implications of different guidelines for surveillance after serrated polyp resection in United States of America and Europe

Arne Bleijenberg
 1  Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Dagmar Klotz
 2  Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
 3  Departments of Pathology and Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Magnus Løberg
 2  Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
 3  Departments of Pathology and Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Evelien Dekker
 1  Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Hans Olov Adami
 2  Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
 4  Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
,
Ernst J. Kuipers
 5  Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
,
Øyvind Holme
 6  University of Oslo and Cancer Registry of Norway, Oslo, and Sorlandet Hospital Trust, Kristiansand, Norway
,
Mette Kalager
 7  Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
,
Louise Emilsson
 7  Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
 8  Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Norway
,
Britta Kleist
 9  Department of Pathology, Soerlandet Sykehus HF, Kristiansand, Norway
,
Leif Løvdal
 9  Department of Pathology, Soerlandet Sykehus HF, Kristiansand, Norway
,
Jaroslaw Regula
10  Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
11  Department of Oncological Gastroenterology, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
,
Else M. Løberg
12  Department of Pathology, Oslo University Hospital, Ullevål, Oslo, Norway
,
Joep IJspeert
 1  Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands
,
Michael Bretthauer
 2  Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
 3  Departments of Pathology and Transplantation Medicine, Oslo University Hospital, Oslo, Norway
› Author Affiliations
Further Information

Publication History

submitted: 04 October 2018

accepted after revision: 10 April 2019

Publication Date:
13 June 2019 (eFirst)

Abstract

Introduction Because individuals with serrated polyps and adenomas are at increased risk of developing new polyps and colorectal cancer (CRC), surveillance after resection is justified. After adenoma resection, most international guidelines are consistent, but recommendations for surveillance after serrated polyp resection vary. The United States Multi-Society Taskforce on CRC (US-MSTF) base surveillance intervals on serrated polyp subtype (traditional serrated adenoma, sessile serrated polyp, hyperplastic polyps), while the European Society of Gastrointestinal Endoscopy (ESGE) guidelines do not take serrated polyp subtype into account. We evaluated the implications of this difference in a primary colonoscopy screening cohort.

Methods We included participants from a large colonoscopy screening trial. In a post-hoc simulation, assuming full protocol adherence, we determined the surveillance interval for each subject based on their polyp burden, using the most recent US-MSTF and ESGE guidelines.

Results We included 5323 participants, of whom 1228 had one or more serrated polyps. In 5201 of all participants (98 %; Cohen’s kappa 0.90) and in 1106 of those with serrated polyps (90 %; Cohen’s kappa 0.80), both guidelines recommended identical surveillance intervals. Recommendations for a 3-year surveillance interval were identical between the two guidelines. All 122 subjects with discordant recommendations would receive a follow-up colonoscopy after 10 years using ESGE guidance and after 5 years using US-MSTF guidance.

Conclusion Despite the different criteria used to determine surveillance after serrated polyp resection, most individuals are recommended identical colonoscopy surveillance intervals whether following the ESGE or US-MSTF guidelines. This suggests that surveillance recommendations do not need to consider the serrated polyp subtype.