ESGE POST-POLYPECTOMY SURVEILLANCE GUIDELINES: ADHERENCE AND RELATION WITH HIGH RISK LESIONS

Aims:

Colorectal cancer (CRC) is one of the main causes of cancer-related death in the western world. Adenoma resection allows reduction of the incidence and mortality caused by CRC. Some patients are still at an increased risk of developing CRC post-polypectomy so an adequate surveillance is essential for its prevention. The aim of this study was to evaluate the adherence to European Society of Gastrointestinal Endoscopy (ESGE) post-polypectomy surveillance guidelines and its relation with the diagnosis of high risk lesions.

Methods:

We identified 40 – 74 year old patients that underwent polypectomy between January and August 2010, posteriorly evaluated on a gastroenterology medical appointment where the recommended surveillance period was defined. Adherence and surveillance colonoscopy findings were determined through consultation of the electronic medical process of each patient. Surveillance colonoscopy was considered adequate when it was undergone on a ± 6-month interval comparatively to ESGE recommended surveillance period.

Results:

176 patients (67.0% male; mean age 61.6 ± 7.6 years) were selected. Post-polypectomy surveillance was inadequate (absent or non-adequate) in 68.2% (n = 120), of which 84.2% (n = 101) did not undergo colonoscopy in any time frame or underwent delayed colonoscopy. There was an association between indication for colonoscopy, family history of CRC, maximum size of the polyps and the diagnosis of high risk lesions or advanced adenomas in the index colonoscopy and the execution of surveillance colonoscopy (p < 0.05). The number of high risk lesions (19.0 Vs. 5.3%) and advanced adenomas (15.5 Vs. 4.0%) was superior in patients who underwent delayed surveillance colonoscopy (p < 0.05). There was no difference in the number of high risk lesions or advanced adenomas between patients with adequate or anticipated surveillance colonoscopy (p > 0.05).

Conclusions:

The adherence to post-polypectomy surveillance guidelines is unsatisfactory. Only approximately one third of patients had adequate surveillance colonoscopy and its delay is associated with an increase in prevalence of high risk lesions.