New risk stratification after colorectal polypectomy reduces burden of surveillance without increasing mortality.
Aged
Aged, 80 and over
Austria
Cohort Studies
Colonic Polyps
/ pathology
Colonoscopy
/ standards
Colorectal Neoplasms
/ diagnosis
Female
Guideline Adherence
Humans
Male
Mass Screening
/ methods
Middle Aged
Practice Guidelines as Topic
Predictive Value of Tests
Reproducibility of Results
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
CRC
cancer
colonoscopy
colorectal cancer
mortality
polypectomy
risk-stratification
screening
surveillance
Journal
United European gastroenterology journal
ISSN: 2050-6414
Titre abrégé: United European Gastroenterol J
Pays: England
ID NLM: 101606807
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
13
01
2021
accepted:
08
03
2021
pubmed:
4
8
2021
medline:
28
1
2022
entrez:
3
8
2021
Statut:
ppublish
Résumé
The 2020 postpolypectomy surveillance guideline update of European Society for Gastrointestinal Endoscopy defines a more restrictive group of individuals in need for surveillance 3 years after colonoscopy. The aim of this cohort study was to validate the new guideline recommendation. Based on a national quality assurance program, we compared the 2020 risk group definition with the previous 2013 recommendations for their strength of association with (1) colorectal cancer death, and (2) all-cause death. A total of 265,608 screening colonoscopies were included in the study. Mean age was 61.1 years (SD ±9.0), and 50.6% were women. During a mean follow-up of 59.3 months (SD ±35.0), 170 CRC deaths and 7723 deaths of any cause were identified. 62.4% of colonoscopies were negative and 4.9% were assigned to surveillance after 3 years according to the 2020 guidelines versus 10.4% following the 2013 guidelines, which corresponds to a relative reduction in colonoscopies by 47%. The strength of association with CRC mortality was markedly higher with the 2020 surveillance group as compared to the 2013 guidelines (HR 2.56, 95% CI 1.62-4.03 vs. HR 1.73, 95% CI 1.13-2.62), while the magnitude of association with CRC mortality for low risk individuals was lower (HR 1.17, 95% CI 0.83-1.63 vs. 1.25, 95% CI 0.88-1.76). Adherence to the updated guidelines reduces the burden of surveillance colonoscopies by 47% while preserving the efficacy of surveillance in preventing CRC mortality.
Sections du résumé
BACKGROUND
The 2020 postpolypectomy surveillance guideline update of European Society for Gastrointestinal Endoscopy defines a more restrictive group of individuals in need for surveillance 3 years after colonoscopy.
AIM
The aim of this cohort study was to validate the new guideline recommendation.
METHODS
Based on a national quality assurance program, we compared the 2020 risk group definition with the previous 2013 recommendations for their strength of association with (1) colorectal cancer death, and (2) all-cause death.
RESULTS
A total of 265,608 screening colonoscopies were included in the study. Mean age was 61.1 years (SD ±9.0), and 50.6% were women. During a mean follow-up of 59.3 months (SD ±35.0), 170 CRC deaths and 7723 deaths of any cause were identified. 62.4% of colonoscopies were negative and 4.9% were assigned to surveillance after 3 years according to the 2020 guidelines versus 10.4% following the 2013 guidelines, which corresponds to a relative reduction in colonoscopies by 47%. The strength of association with CRC mortality was markedly higher with the 2020 surveillance group as compared to the 2013 guidelines (HR 2.56, 95% CI 1.62-4.03 vs. HR 1.73, 95% CI 1.13-2.62), while the magnitude of association with CRC mortality for low risk individuals was lower (HR 1.17, 95% CI 0.83-1.63 vs. 1.25, 95% CI 0.88-1.76).
CONCLUSIONS
Adherence to the updated guidelines reduces the burden of surveillance colonoscopies by 47% while preserving the efficacy of surveillance in preventing CRC mortality.
Identifiants
pubmed: 34343405
doi: 10.1002/ueg2.12119
pmc: PMC8498405
doi:
Types de publication
Comparative Study
Journal Article
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
947-954Informations de copyright
© 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.
Références
United European Gastroenterol J. 2017 Apr;5(3):309-334
pubmed: 28507745
Endoscopy. 2016 Dec;48(12):1102-1109
pubmed: 27576182
Endoscopy. 2016 Jun;48(6):571-8
pubmed: 27042931
Gastroenterology. 2016 Apr;150(4):895-902.e5
pubmed: 26677986
Gastroenterology. 2020 Mar;158(4):884-894.e5
pubmed: 31589872
Lancet Oncol. 2017 Jun;18(6):823-834
pubmed: 28457708
JAMA. 2018 May 15;319(19):2021-2031
pubmed: 29800214
N Engl J Med. 2012 Feb 23;366(8):687-96
pubmed: 22356322
N Engl J Med. 1993 Dec 30;329(27):1977-81
pubmed: 8247072
Lancet. 2017 Apr 1;389(10076):1299-1311
pubmed: 28236467
Ann Intern Med. 2018 Jun 5;168(11):775-782
pubmed: 29710125
Gastroenterology. 2012 Sep;143(3):844-857
pubmed: 22763141
United European Gastroenterol J. 2021 Oct;9(8):947-954
pubmed: 34343405
Gastroenterology. 2020 Mar;158(4):852-861.e4
pubmed: 31302144
Gastrointest Endosc. 2014 Aug;80(2):299-306
pubmed: 24796960
Scand J Gastroenterol. 1992;27(1):47-52
pubmed: 1736342
N Engl J Med. 1993 May 13;328(19):1365-71
pubmed: 8474513
Endoscopy. 2020 Aug;52(8):687-700
pubmed: 32572858
JAMA. 2011 Sep 28;306(12):1352-8
pubmed: 21954479
N Engl J Med. 1988 Sep 1;319(9):525-32
pubmed: 2841597
Lancet Gastroenterol Hepatol. 2020 Jun;5(6):537-547
pubmed: 32192628
Gut. 2012 Aug;61(8):1180-6
pubmed: 22110052
Gastroenterology. 2020 Mar;158(4):875-883.e5
pubmed: 31563625
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
Ann Intern Med. 2020 Jul 21;173(2):81-91
pubmed: 32449884
Lancet. 1989 May 27;1(8648):1160-4
pubmed: 2566735
Gastrointest Endosc. 2014 Jul;80(1):133-43
pubmed: 24565067
Gastroenterology. 2019 Oct;157(4):949-966.e4
pubmed: 31323292
Endoscopy. 2013 Oct;45(10):842-51
pubmed: 24030244