Intest Res.  2024 Apr;22(2):186-207. 10.5217/ir.2023.00109.

A survey of current practices in post-polypectomy surveillance in Korea

• Kim J
• Gweon TG
• Kwak MS
• Kim SY
• Kim SJ
• Kim HG
• Kim ER
• Hong SN
• Kim ES
• Moon CM
• Myung DS
• Baek DH
• Oh SJ
• Lee HJ
• Lee JY
• Jung Y
• Chun J
• Yang DH
• on behalf of the Intestinal Tumor Research Group of the Korean Association for the Study of Intestinal Diseases (KASID)

• KMID: 2554662
• DOI: http://doi.org/10.5217/ir.2023.00109

Abstract

Background/Aims
We investigated the clinical practice patterns of post-polypectomy colonoscopic surveillance among Korean endoscopists.
Methods
In a web-based survey conducted between September and November 2021, participants were asked about their preferred surveillance intervals and the patient age at which surveillance was discontinued. Adherence to the recent guidelines of the U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) was also analyzed.
Results
In total, 196 endoscopists completed the survey. The most preferred first surveillance intervals were: a 5-year interval after the removal of 1–2 tubular adenomas < 10 mm; a 3-year interval after the removal of 3–10 tubular adenomas < 10 mm, adenomas ≥ 10 mm, tubulovillous or villous adenomas, ≤ 20 hyperplastic polyps < 10 mm, 1–4 sessile serrated lesions (SSLs) < 10 mm, hyperplastic polyps or SSLs ≥ 10 mm, and traditional serrated adenomas; and a 1-year interval after the removal of adenomas with highgrade dysplasia, >10 adenomas, 5–10 SSLs, and SSLs with dysplasia. In piecemeal resections of large polyps ( > 20 mm), surveillance colonoscopy was mostly preferred after 1 year for adenomas and 6 months for SSLs. The mean USMSTF guideline adherence rate was 30.7%. The largest proportion of respondents (40.8%–55.1%) discontinued the surveillance at the patient age of 80–84 years.
Conclusions
A significant discrepancy was observed between the preferred post-polypectomy surveillance intervals and recent international guidelines. Individualized measures are required to increase adherence to the guidelines.

Keyword

Colonoscopy; Colonic polyps; Colon; Rectum

Figure

• 

  Fig. 1. Preferred first and second post-polypectomy surveillance intervals of respondents when the following conventional adenomas were removed by an adequate index colonoscopy in the asymptomatic average-risk population: (A) 1–2 TAs <10 mm, (B) 3–4 TAs <10 mm, (C) 5–10 TAs <10 mm, (D) an adenoma ≥10 mm, (E) an adenoma with tubulovillous or villous histology, (F) an adenoma with HGD, (G) >10 adenomas on single examination, and (H) piecemeal resection of an adenoma ≥20 mm. TA, tubular adenoma; HGD, high-grade dysplasia.

• 

  Fig. 2. Preferred first and second post-polypectomy surveillance intervals of respondents when the following serrated polyps were removed by an adequate index colonoscopy in the asymptomatic average-risk population: (A) ≤20 HPs in the rectum or sigmoid colon <10 mm, (B) ≤20 HPs proximal to the sigmoid colon <10 mm, (C) 1–2 SSLs <10 mm, (D) 3–4 SSLs <10 mm, (E) 5–10 SSLs <10 mm, (F) an SSL ≥10 mm, (G) an SSL with dysplasia, (H) an HP ≥10 mm, (I) a TSA, and (J) piecemeal resection of an SSL ≥20 mm. HP, hyperplastic polyp; SSL, sessile serrated lesion; TSA, traditional serrated adenoma.

• 

  Fig. 3. Adherence to post-polypectomy surveillance guidelines in various clinical scenarios [8]. TA, tubular adenoma; TVA, tubulovillous adenoma; HGD, high-grade dysplasia; HP, hyperplastic polyp; SSL, sessile serrated lesion; TSA, traditional serrated adenoma.

• 

  Fig. 4. Patient age at which post-polypectomy surveillance colonoscopy was discontinued (A, B). HP, hyperplastic polyp; TA, tubular adenoma; TVA, tubulovillous adenoma; HGD, high-grade dysplasia.

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  Fig. 5. Major factors influencing the post-polypectomy surveillance interval compared with the previous study’s results [11]. CRC, colorectal cancer; ADR, adenoma detection rate. aP<0.05, bP<0.01, cP<0.001.

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