Individuals with polyps ≥10mm without other high-risk features have a similarly low post-colonoscopy colorectal cancer risk as those with no polyps

Background and study aims Current post-polypectomy guidelines recommend a 3-year surveillance colonoscopy for individuals with polyps ≥10mm as the sole high-risk feature, though the necessity of such strict surveillance, particularly for 10-20mm polyps, remains uncertain. We aimed to compare post-colonoscopy colorectal cancer (PCCRC) risk between these individuals and those without polyps at baseline colonoscopy. Patients and methods Data of quality-assured baseline colonoscopies in the Dutch fecal immunochemical test-based CRC screening program (2014-2020) was used. According to the guidelines prevailing at that time, a subset of individuals with ≥10mm adenomas without high-grade dysplasia or serrated polyps ≥10mm without dysplasia were advised 5-year surveillance. For these individuals, PCCRC-risk within 5 years was assessed and compared to the risk of polyp-free individuals using multilevel cox regression analysis. Results Of all individuals with high-risk polyps, 79% had polyps ≥10mm and 46% had polyps 10-20mm as sole high-risk feature. In total 21.522 individuals with ≥10mm polyps and 68.688 individuals without polyps were included for comparative analyses. PCCRC incidence per 10,000 person-years of follow up was 3.07 (95%CI 1.76-4.38) for individuals with ≥10mm polyps and 5.02 (95%CI 4.08-5.97) for individuals without polyps. Risk of PCCRC was comparable between both groups (HR 0.67;95%CI 0.42-1.07). Conclusions PCCRC-risk 5 years after baseline colonoscopy within individuals with polyps ≥10mm without other high-risk features is not significantly different from individuals without polyps at baseline. Lengthening surveillance intervals would affect 79% of high-risk individuals with ≥10mm polyps as their sole high-risk feature, and 46% if limited to those with 10-20mm polyps.

Publikationsverlauf

Eingereicht: 05. Juni 2025

Angenommen nach Revision: 23. Oktober 2025

Accepted Manuscript online:
23. Oktober 2025