Five-year surveillance interval after polypectomy appropriate

Results of a study support recent recommendations to wait at least 5 years following polypectomy for low-risk adenomas before performing surveillance colonoscopy. A 5-year surveillance window might also be sufficient after removal of high-risk adenomas, according to the study.


Dr. Hermann Brenner, from the German Centre for Research on Ageing in Heidelberg, and colleagues compared the risk of colorectal cancer up to 10 years after large bowel endoscopy in 454 patients who had polypectomy with the risk for 391 matched subjects who had never undergone large bowel endoscopy (the controls).Polypectomy patients had a "strongly and significantly reduced risk" of colorectal cancer up to 5 years after endoscopy, relative to subjects who had never had endoscopy, the investigators report in the August issue of the American Journal of Gastroenterology.

Compared to this latter group, the odds ratios of colorectal cancer up to 2 years and 3 to 5 years after polypectomy were 0.16 and 0.27, respectively.Risk of colorectal cancer was significantly reduced (OR, 0.27) within 5 years even after detection and removal of high-risk polyps, Dr. Brenner and colleagues also found.

Although a nonsignificantly increased risk of colorectal cancer was found between 6 and 10 years after polypectomy, overall risk reduction within 10 years following polypectomy remained strong and statistically significant among patients for whom no high-risk adenomas were recorded, the authors report.In an accompanying editorial, Dr. Theodore R. Levin of Kaiser Permanente Medical Center, Walnut Creek, California makes the point that post-polypectomy surveillance colonoscopy is "often done sooner than guidelines recommend."Aggressive post-polypectomy surveillance, he warns, "exposes patients to risk of complications, with minimal benefit, (and) diverts colonoscopy resources away from the more valuable practice of primary screening."

Reference :

http://www.oncolink.org/resources/article.cfm?c=3&s=8&ss=23&Year=2007&Month=08&id=14449