Introduction

There are no randomised clinical trials evaluating the effect of endoscopic surveillance on the long-term incidence of colorectal cancer. In this context, it is relevant to know te preferences of the patiens. The Polyprev study (NCT04967183) is a randomised clinical trial evaluating the impact of the incidence on colorectal cancer incidence of faecal occult blood surveillance versus endoscopic surveillance after resection of advanced lesions in screening programmes.

Aims & Methods

The aim of our study is to know the preferences of surveillance after resection of advanced lesions. Included patiens were presented with a decision support tool using vignettes, presenting 8 scenarios based on estimated incidences of colorectal cancer, number of colonoscopies and associated complications. In each scenario, patient chose one of the following options: endoscopic surveillance, faecal occult blood surveillance or no surveillance. We conducted a descriptive analysis of the responses obtained in the questionnaires. Subsequently, we determined which variables were independently associated with a preference for endoscopic surveillance using a multivariate logistic regression.

Results

Out of he 1023 patients included, 521 subjects answered to the values and preferences questionnaire. The mean age was 57.89 (±4.87) years, the percentage of women was 39.3% and the mean of resected adenomas was 3.07(±2.01) adenomas per patient. In the 8 scenarios, the preferente rate for endoscopic surveillance, faecal occult blod surveillance and no surveillance was 32.8 - 4.5%, 55.7 - 66.2% and 0.6 - 1.4%, respectively. The endoscopic surveillance was significatly associated with the female gender (OR: 1.27 95% CI: 1.11 - 1.44), the age (50 - 54 year OR: 1.25 95% CI: 1.07 - 1.47; 55 - 59 years OR: 1.47 95% CI: 1.26 - 1.72), the assigment to the colonoscopy branch (OR: 1.93 95% CI: 1.69 - 2.20) and the risk of colorectal cancer estimated by faecal occult blood surveillance (2% OR: 1.43 95% CI: 1.04 - 1.97; 2.5% OR 1.67 95% CI: 1.29 - 2-32).

Conclusion

Patients in the Polyprev study prefer to return to the colorectal cancer screening programme. Variables independently associated with endoscopic surveillance were sex, age, assigned stduy branch and estimated risk of colorectal cancer.

Introduction

In colonoscopies with colorectal neoplasia, the endoscopy therapy is recommended. The surveillance (follow-up, FU) colonoscopies follow with the aim to diagnose the recurrent and metachronous lesions. Many guidelines recommend the intervals of such procedures based on the number, size and histopathological phenotype of the resected lesions. In clinical practice, the adherence of the recommendations is variable and selection of the high-risk patients who will benefit from shorter intervals might be helpful. Therefore, detailed study focusing on the development and clinical utilization of the new method combining the clinicopathological phenotype and the mutation burden was started in 2017. The interim results of the clinical phase of the prospective study are described.

Aims & Methods

Patients with colorectal lesions ≥ 10 mm removed by advanced therapeutic methods (en-bloc mucosal resection and submucosal dissection) and followed in interval in year 1, 3 and 5 were included. The therapy and surveillance were performed in one tertiary endoscopy center. The main aim was to assess the metachronous lesions (number, size, locality, histopathology characteristics) in relation with the index colonoscopy findings. Secondary aim was evaluation of the local residual neoplasia (LRN) in the scar after previous therapy.

Results

There were 217 patients included in the study in years 2017 – 2020. Eight of them were excluded because they did not meet the inclusion criteria. Results of the index colonoscopy in 209 patients (130 men, 62,2%; 79 women, 37,8%) were analyzed. 275 index lesions were found, majority of them (238 lesions, 86,5 %, low-grade and high-grade adenomas) were benign and there were 12 (4,4%) intramucosal cancers, two T1 cancers, one T2 cancers and one NET. 21 lesions were hyperplastic or others. Follow-up colonoscopy in one year was performed in 178 patients (82,0%) and in 91 of them (51,1 %) metachronous lesions were found, 120 (64,2%) adenomas, 46 (24,6%) hyperplastic and 21 (11.2%) others, with no cancer. LRN was diagnosed in 5,5% patients. In 122 patients with 3-years FU colonoscopy, 59 (48,4%) had metachronous lesions, mostly adenomas (73; 72,3%), no cancer and one LRN found. 45 patients had 5-years FU colonoscopy so far, 22 of them (48,9%) with metachronous lesions, mostly adenomas (25; 54,3%), no cancer, LRN in one case.

Conclusion

In patients after removal of the high-risk colorectal lesions defined by size ≥ 10 mm, high numbers of metachronous lesions were found in the strict surveillance protocol (years 1, 3, and 5). All the lesions were benign, with no cancer found.

References

Supported by program projects of the Ministry of Health of the Czech Republic with reg. no. NU22-08-00424, MO1012 and Cooperatio.

Introduction

Serrated polyps (SPs) are precursors to 15–20% of colorectal cancers (CRCs). However, there are uncertainties regarding which SPs require surveillance and at what intervals, with recommendations adapted from those for adenomas in the absence of solid evidence.

Aims & Methods

Our aim was to assess which SP risk characteristics relate to a higher risk of metachronous CRC or advanced polyps. We systematically searched PubMed, EMBASE, and Cochrane for cohort, case-control studies, and clinical trials from inception to Dec 31, 2023, for CRC or advanced polyps [advanced adenoma (AA) or advanced SP] incidence at surveillance stratified by baseline SP size, dysplasia, location, and multiplicity. CRC and advanced polyp incidence per 1,000 person-years (p-y) were estimated. We performed a meta-analysis by calculating pooled relative risks (RR) using a random-effects model.

Results

5,903 studies were reviewed and 14 included, with 493,949 patients (mean age 59·5 years, 55% men). Mean follow-up was 4·9 years. CRC incidence per 1,000 p-y was 2·09 (95%CI 1·29–2·90) for advanced SP, 1·52 (0·78–2·25) for SP>10mm, 5·86 (2·16–9·56) for SP with dysplasia, 1·18 (0·77–1·60) for proximal SP, 0·52 (0·08–1·12) for >3SP, 0·50 (0·35–0·66) for non-advanced SP, and 0·44 (0·41–0·46) for normal colonoscopy. Metachronous CRC risk was higher in advanced SP vs non-advanced SP (RR 1·84, 95%CI 1·11–3·04), and vs normal colonoscopy (RR 2·92, 2·26–3·77); in SP>10mm vs <10mm (RR 2·61, 1·43–4·77), and vs normal colonoscopy (RR 3·52, 2·17–5·69); and in SP with dysplasia vs normal colonoscopy (RR 2·71, 2·00–3·67). No increase in CRC or advanced polyp risk was found in patients with proximal vs distal SP, nor in >3SP vs 1–2SP.

Conclusion

CRC risk is significantly higher in patients with baseline advanced SP after 4·9 years of follow-up, with risk magnitudes similar to those described for AA, supporting the current recommendation for 3-year surveillance in patients with advanced SP.

Disclosure

RJ has received research grants from MSD, and has participated as an advisor to MSD, Norgine, Alpha-Sigma, and GISupply. UL has participated in the advisory board (UniversalDx, Lean Medical, Vivante, Kohler Ventures), and as consultant (Medtronic, Clinical Genomics, Guardant Health, Freenome, ChekCap). MDR has no COI since start of 2020 (Advisor for Norgine in 2019). The rest of authors have nothing to disclose.

Introduction

Familial adenomatous polyposis (FAP) is a hereditary syndrome caused by a pathogenic variant in the APC gene, responsible for 1–2% of colorectal cancers (CRC) and associated with a near 100% lifetime CRC risk. Prophylactic colectomy or proctocolectomy reduces CRC incidence and mortality but does not eliminate the risk of rectal or pouch cancer (2–24%). The ESGE recommends endoscopic surveillance every 1–2 years, taking into account the number, size, and histological features of the polyps. However, these recommendations are mainly based on expert opinions, with limited current evidence available to optimize surveillance guidelines and define endoscopic quality standards.

Aims & Methods

To analyze the quality parameters of endoscopic surveillance and their association with the development of advanced neoplasia in the rectal remnant or reservoir among familial adenomatous polyposis (FAP) patients after prophylactic (procto)colectomy.
A retrospective observational study was conducted including FAP patients who underwent prophylactic colectomy or proctocolectomy and were registered between 1983 and 2022 at the Hospital Clínic de Barcelona. Numerical variables were analyzed using the Mann-Whitney U test, and categorical variables were evaluated with the Chi-square test. Logistic regression was performed to identify independent variables associated with the development of advanced neoplasia.

Results

Of the 85 eligible patients, 61 (64% women; median age, 53 years [range, 39–59]) met the inclusion criteria. Seven patients (11.5%) were diagnosed with advanced neoplasia (AN), of whom six had ileorectal anastomosis and one had ileoanal pouch anastomosis. Of these seven patients, three (43%) developed cancer, while four (57%) presented advanced adenomas in the rectal remnant or reservoir. Patients with AN underwent lower-quality endoscopic procedures compared to those without AN: the use of high-definition endoscopes was 42.9% vs. 94.4% (p=0.002), retroflexion was performed in 14.2% vs. 68.5% (p=0.005), adequate bowel preparation was achieved in 42.8% vs. 87% (p=0.004), procedures were performed in a dedicated endoscopy program in 28.5% vs. 79.6% (p=0.004), and the mean number of polyps removed was 1.1 ± 0.9 vs. 3.4 ± 4.2 (p=0.001), respectively. In the multivariable analysis, the only independent variable associated with the development of advanced neoplasia was the non-use of high-definition endoscopes.

Conclusion

The development of advanced neoplasia is associated with lower quality in endoscopic surveillance parameters among FAP patients who underwent prophylactic (procto)colectomy. These findings highlight the need to establish specific quality indicators to optimize endoscopic surveillance in this high-risk population.
In light of these preliminary findings, the study has been expanded to a European multicenter phase and is currently in the patient recruitment stage.

Introduction

Endoscopic treatment of the colorectal lesions involving the diverticulum is difficult, due to the lack of muscular layer. There have been no investigations of the safety and feasibility of treatment strategy for the polyp close to or extending into the diverticulum. We investigated the outcomes of our treatment strategy for involving the diverticulum and verify the safety and the feasibility of our strategy.

Aims & Methods

Between November 2014 and January 2022, 33 cases of 33 diverticular polyp (16 males/17 females, age were 74 (54-92) years old) were enrolled in this study. Our treatment strategy for the colorectal lesions involving the diverticulum is determined by the location of polyps and diverticulum, the size of polyp, and the potential of malignancy. Cold polypectomy (CP) and gel-immersion EMR (GIEMR) are selected for the benign polyp of 10 mm or less that can be snared. The polyp with large diverticular openings, we try to inverted diverticulum.When snaring is difficult, ESD is performed. The lesions close to the diverticular opening could be resected by first incising and trimming the area close to the diverticular opening. When lesions extending into the diverticulum, ESD with the ring thread traction is performed. If traction alone cannot complete the procedure, ESD with a minor incision in the muscular layer is used in combination with traction.

Results

3 cases of CSP, 8 cases of GI EMR, and 22 cases of ESD were performed. All cases in which CSP was performed were flat type, two polyps were located in the ascending colon and one in the sigmoid colon, the median size of polyps is 3 (3-5) mm, and all polyps were adenomas. The median time of treatment was 3 (2-5) minutes, en-bloc resection was achieved in all cases, and resected margins were all negative. GI EMR: Endoscopic classification were flat type lesions in 5 cases and elevated type lesions in 3, Four polyps were located in the ascending colon and one each in the cecum, transverse colon, descending colon, sigmoid colon, the median size of lesions is 10 (8-15) mm, the pathological findings were adenomas in 5 cases and SSLs in 3 cases. The median time of treatment was 5 (2-10) minutes, en bloc resection in all cases, and margins were negative. ESD: Of the 22 cases, 17 lesions located near the diverticular opening, and 5 lesions extended completely into the diverticulum. The lesions that extended into the diverticulum, 1 case was resected by diverticulum inversion, 3 cases by ring thread traction, and 1 case by traction with a minor incision in the muscular layer. Endoscopic classification were flat type lesions in 11, elevated type lesions in 11, 5 lesions were located in the cecum, 10 lesions in the ascending colon, one lesion in transverse colon, 6 lesions in sigmoid colon, the median size of lesions is 25 (10-108) mm, the pathological findings were adenomas in 5 cases and intramucosal carcinoma in 17 cases. The median time of treatment was 35 (14-120) minutes, the median diameter of resection was 35 (20-110) mm, no complications were observed, and the horizontal margins were negative.

Conclusion

Endoscopic treatment can be performed safely by selecting a treatment method/strategy suitable for the characteristics of the colorectal lesions involving the diverticulum.