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UEG Presentation

IMPACT OF USING THE ESGE GUIDELINE RISK-PROFILES FOR SURVEILLANCE AS OUTCOME PARAMETER IN A FIT-BASED COLORECTAL CANCER SCREENING PROGRAM

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IMPACT OF USING THE ESGE GUIDELINE RISK-PROFILES FOR SURVEILLANCE AS OUTCOME PARAMETER IN A FIT-BASED COLORECTAL CANCER SCREENING PROGRAM

Elyse Emmelie Catharina Rijnders 1, Esther Toes-Zoutendijk 2, Sybrand De Boer 3, Ruud Schauwen 4, Marco Oudkerk Pool 5, Claudia Verveer 6, Evelien Dekker 7, Monique van leerdam 8, Iris Nagtegaal 9, Manon C.W. Spaander 10

Affiliations

1 Erasmus MC University Medical Center, Rotterdam, Netherlands

2 University Medical Center Rotterdam, Rotterdam, Netherlands

3 Slingeland Hospital, Doetinchem, Netherlands

4 Bernhoven hospital, Uden, Netherlands

5 Wilhelmina hospital, Assen, Netherlands

6 Ikazia Ziekenhuis, Rotterdam, Netherlands

7 AMC, Amsterdam, Netherlands

8 Netherlands Cancer Institute, Amstelveen, Netherlands

9 Radboud University Nijmegen Medical Center Dept. of Pathology, Nijmegen, Netherlands

10 Erasmus Medical Center Rotterdam, Rotterdam, Netherlands

Summary

AI Generated

Applying the 2020 ESGE risk-profile surveillance guideline to FIT-based colorectal cancer screening in the Netherlands would reduce total surveillance colonoscopies by 18.9% but double the number requiring 3-year surveillance.

In 218,109 persons with positive FIT (≥47 µg Hb/g feces) undergoing colonoscopy 2019-2022, the new guideline reduced overall surveillance from 51.2% to 32.3% of the screened population.
The 3-year surveillance interval increased from 16.0% (35,004 persons) to 32.3% (70,146 persons), while the 5-year interval was eliminated and return-to-screening increased from 44.1% to 63.2%.
The new guideline defines high-risk profile as high-risk adenoma (≥10mm or high-grade dysplasia), high-risk serrated polyp (≥10mm or any dysplasia), or ≥5 adenomas, all triggering 3-year surveillance.
The positive predictive value for detecting CRC, high-risk adenoma, or high-risk serrated polyps was 34.4%, an increase of 1.7% (p<0.05) compared to the prior advanced neoplasia definition.
Of note, 34,451 persons previously assigned 5-year surveillance and 723 previously discharged to screening now require 3-year surveillance under the risk-profile approach.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Recent guideline from the European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of risk-profiles to determine surveillance colonoscopy after polypectomy.¹ These risk-profiles are potentially a better predictor for the development of colorectal cancer (CRC) incidence after polypectomy. CRC screening programs use advanced neoplasia as primary outcome parameter.² It might be more recognizable for doctors and policy makers to use the same outcome parameter. However, by changing the outcome parameter from advanced neoplasia to high-/low-risk profiles in a FIT-based CRC screening program, the definition of what is considered a relevant lesions will change. Using risk-profiles as outcome parameter may impact both colonoscopy surveillance capacity and the positive predictive value (PPV) of finding a relevant lesions after a positive FIT.

Aims & Methods

Study aim: assessing the impact of applying the ESGE risk-profiles as outcome parameter of a FIT based CRC screening program on colonoscopy surveillance and PPV after a positive FIT.
Methods: We retrospectively analyzed all persons who had a positive FIT (≥ 47µg Hb/g feces) followed by a colonoscopy in the Dutch CRC screening program from 2019-2022. Colonoscopy and pathology reports were used to define the surveillance interval based on the old and new guideline.
The old guideline used a scoring table in which, adenoma count, location, villous type (≥ 75%) or the presence of an adenoma or serrated polyp ≥ 10mm were used to determine a 3 or 5 year surveillance interval.² The new guideline defined a high-risk profile as either a high-risk adenoma or high-risk serrated polyp or ≥ 5 adenomas. A high-risk adenoma is an adenoma ≥ 10mm or with high-grade dysplasia. A high-risk serrated polyp is a serrated polyp ≥ 10mm or with any dysplasia.³All persons with a high-risk profile receive surveillance in 3 years.
The old definition of the PPV was advanced neoplasia. Advanced neoplasia is defined as CRC or advanced adenoma (adenoma ≥ 10mm or high-grade dysplasia or ≥ 25% villous type).³ The new definition of the PPV was CRC, high-risk adenoma or high-risk serrated polyps. A chi-squared test was used to determine significant differences between the old and new definition.

Results

218,109 persons with a positive FIT underwent a colonoscopy between 2019-2022. Based on the old surveillance guideline, 51.2% of the persons would require colonoscopy surveillance. When applying high-risk profiles only 32.3% persons required surveillance. However, the number of persons referred for a 3-year surveillance interval was now doubled (Table 1). This is a result of 723 persons who first qualified for 10-year return to screening, and 34,451 persons who previously had a 5-year interval. In contrast, only 32 persons who initially had a 3-year interval will be advised to return to screening in 10 years, when risk-profiles are applied. The corresponding PPV for CRC, high-risk adenoma or high-risk serrated polyps was 34.4%, showing an increase of 1.7% (p < 0.05) compared to PPV based on advanced neoplasia.

Table 1: surveillance count based on the old surveillance guideline and the new surveillance guideline
	Treatment CRC		Surveillance 3- years		Surveillance 5-years		Return to screening in 10 years
Old surveillance guideline	10,163	(4.7%)	35,004	(16.0%)	76,856	(35.2%)	96,086	(44.1%)
New surveillance guideline	10,163	(4.7%)	70,146	(32.3%)	x	x	137,800	(63.2%)

Conclusion

This study shows that when the new ESGE surveillance guideline risk-profiles are applied as outcome parameter in FIT CRC screening, a total reduction of 18.9% of surveillance colonoscopies can be achieved although the number of persons in the 3-year surveillance interval will be doubled. A minor change in PPV can be expected.

References

Hassan C, Antonelli G, Dumonceau JM, Regula J, Bretthauer M, Chaussade S, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Vol. 52, Endoscopy. Georg Thieme Verlag; 2020. p. 687–700.
Nederlandse Vereniging van maag-darm-leverartsen (NVMDL) Nederlandse coloscopie surveillance richtlijn 2013 [Internet] cited April 2024, https://www.mdl.nl/files/richlijnen/Richtlijn_Coloscopie_Surveillance_definitief_2013.pdf
Federatie Medisch Specialisten (FMS) richtlijn colorectal carcinoom [Internet] cited April 2024, available from https://richtlijnendatabase.nl/richtlijn/coloscopie_surveillance/startpagina.html

Event

UEG Week Vienna 2024

Topics

Colorectal Digestive Oncology Endoscopy

Submission format

Abstract

Session

Fit for CRC screening

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Score, mean (sd)	Baseline MED-LFD	Baseline NICE	1st FU MED-LFD	1st FU NICE	2nd FU MED-LFD	2nd FU NICE
GSRS (LGI)	4.02 (0.94)	3.95 (0.82)	2.35 (0.82)^{*, $}	3.3 (1.2)^*	2.53 (1.18)^{*, $}	3.44 (1.39)^*
SF-12 total	40.2 (7.9)	39.3 (7.0)	46.5 (6.9)^{*, $}	43.3 (7.8)^*	48.9 (8.0)^{*, $}	42.9 (8.3)
IBS-QoL total	47.5 (20.6)	49.4 (21.5)	71.7 (16.8)^{*, $}	58.3 (22.4)^*	73.7 (21.1)^{*, $}	61 (21.5)^*
HADS anxiety	8.94 (4.64)	9.45 (4.67)	6.77 (4.11)^{*, $}	8.62 (4.96)	5.81 (4.51)^{*, $}	8.39 (4.75)
HADS depression	8.10 (4.68)	8.59 (3.82)	5.22 (3.97)^{*, $}	7.41 (3.95)^*	4.79 (4.13)^{*, $}	7.66 (4.29)

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