IMPLEMENTATION OF BOTH BSG 2019 AND ESGE 2020 POLYPECTOMY SURVEILLANCE GUIDELINES SAFELY REDUCES THE BURDEN OF SURVEILLANCE IN A SCREENING COHORT – A VIRTUAL MODEL STUDY

Aims To evaluate the impact of BSG 2019 and ESGE 2020 polypectomy surveillance guidelines within a national FIT-based bowel cancer screening (BS) cohort on surveillance activity and detection of pathology by retrospective virtual application.

Methods A retrospective review of BS colonoscopies performed in 2015-2016 with 5 years prospective follow up in single institution. Index colonoscopies were selected. Incomplete colonoscopies were excluded. Histology of all resected polyps was reviewed. Surveillance intervals were calculated according to BSG 2019 and EGSE 2020 guidelines compared to pre-existing ‘European guidelines for quality assurance in colorectal cancer screening and diagnosis’ (EUQA 2013). Total number of colonoscopies deferred by virtual implementation of BSG 2019 and ESGE 2020 guidelines were calculated. Pathology identified on procedures that would have been deferred was reviewed.

Fig. 1

Results Total number of index BS colonoscopies performed in 2015-2016 inclusive was 892. 117 were excluded (23 no caecal intubation, 51 inadequate bowel preparation, 48 incomplete polyp clearance). N=609 colonoscopies were scheduled following index colonoscopy in 2 surveillance rounds based on EUQA. Overall, volume of surveillance was significantly reduced with retrospective application of BSG 2019 (n=268, P value<0.0001); and ESGE 2020 (n=433 P value<0.0001). No cancers were detected within the ‘potentially deferred’ procedures who attended for follow up (n=145). High risk findings were found in 3% (9/145) and 2% (7/145) colonoscopies within the BSG and ESGE cohorts (P value=0.7980), respectively.

Table 1

Guidelines	No. colonoscopies following Index N=775	No. colonoscopies following 1st surveillance N=221	No. colonoscopies following 2nd surveillance N=114	Total number of colonoscopies
EUQA 2013	289	213	107	609
BSG 2019	189 (P value < 0.0001)	71 (P value < 0.0001)	8 (P value < 0.0001)	268 (P value < 0.0001)
ESGE 2020	224 (P value < 0.0001)	172 (P value < 0.0001)	37 (P value < 0.0001)	433 (P value < 0.0001)

Conclusions Both BSG 2019 and EGSE 2020 polypectomy guidelines safely reduce the burden of colonoscopy demand with acceptable pathology findings on deferred colonoscopies.

Publication History

Article published online:
14 April 2022