Gastroenterology · General Practice · 2 h ago
Five-year surveillance after high-risk adenoma removal was noninferior to three years
In a randomized noninferiority study of more than 10,000 patients with high-risk adenomas, colorectal cancer incidence at five years was similar with first surveillance colonoscopy at five versus three years. The five-year strategy involved almost 50% fewer colonoscopies, according to a report in the Norwegian Medical Journal.
- Five-year cancer incidence was 0.77% versus 0.82%.
- The difference met the prespecified noninferiority criterion.
- The five-year strategy involved almost 50% fewer colonoscopies.
Current recommendations call for surveillance colonoscopy three years after removal of adenomas with increased malignancy risk. The randomized noninferiority study assigned more than 10,000 patients with high-risk adenomas to a first follow-up colonoscopy at either three or five years; patients assigned to the three-year group also underwent colonoscopy at five years. The study was part of the European EPoS project.
At five years, cumulative colorectal cancer incidence was 0.77% in the five-year group and 0.82% in the three-year group, a difference of −0.05 percentage points that was within the prespecified noninferiority margin. Among the small number of patients diagnosed with cancer, the distribution of early- and late-stage disease did not differ substantially between groups. The five-year strategy involved almost 50% fewer colonoscopies.
These findings suggest that extending the first surveillance interval may reduce colonoscopy burden without a higher five-year cancer incidence in this study population. The source does not provide the noninferiority margin, detailed participant characteristics, or complication outcomes. The report’s prediction that guidelines may change is not itself a guideline update; the findings should be interpreted in light of the full study and existing recommendations.
In practice
For patients with high-risk adenomas, this randomized noninferiority study found similar five-year colorectal cancer incidence when the first surveillance colonoscopy was scheduled at five rather than three years: 0.77% versus 0.82%. The five-year strategy involved almost 50% fewer colonoscopies, and cancer stage distribution among cases was not substantially different. This is potentially practice-relevant evidence, but the source is a brief report and does not supply the noninferiority margin, detailed eligibility criteria, or full safety and follow-up results. It does not itself change guidelines.
AI-generated clinical interpretation · Not editor-reviewed
Is this summary clinically accurate?
Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.
Sign in to rate this summary →Source
Tidsskrift for Den norske legeforening: Koloskopi etter fjerning av tarmpolypper kan utsettes ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.