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An Imperial-led study could help shape international colonoscopy guidelines, potentially easing pressure on healthcare systems and patients.

A new study from the Surgery and Cancer Theme has provided crucial insights into who needs ongoing monitoring for bowel cancer by colonoscopy after initial polyp removal (known as 鈥榩ost-polypectomy surveillance鈥�) – findings that could refine global bowel cancer surveillance practices.

鈥淭hese findings could reduce the number of unnecessary colonoscopies, lessening the burden on healthcare systems and sparing patients from invasive procedures they may not need.鈥� Professor Amanda Cross Surgery & Cancer Theme Co-Lead

Published in GUT, the study titled 鈥溾�� was led by Imperial鈥檚聽. The research addresses a major evidence gap in bowel cancer prevention, namely, which patients need to continue having post-polypectomy surveillance beyond their first surveillance colonoscopy.

Bowel cancer develops from polyps – small growths in the bowel that can turn cancerous over time. While removing polyps via colonoscopy significantly reduces bowel cancer risk, current guidance varies internationally on how long patients should continue to undergo post-polypectomy surveillance.

鈥淔or people entering post-polypectomy surveillance, there is a lack of data to identify those needing a second surveillance colonoscopy,鈥� said first author,聽. 鈥淭his study provides much-needed evidence on this topic, which will be valuable in informing recommendations for ongoing post-polypectomy surveillance in future iterations of the UK, European, and US post-polypectomy surveillance guidelines.鈥�

The research team analysed data from over 10,500 patients and found that:

1. Patients with high-risk polyp findings at both their initial (baseline) and first surveillance colonoscopy had a significantly higher risk of developing bowel cancer than the general population. The researchers report that these patients should have a second surveillance colonoscopy.
2. Patients with low-risk findings at their first surveillance colonoscopy – regardless of whether they had low-risk or high-risk findings at their baseline colonoscopy 聽– were not at increased risk of bowel cancer compared to the general population. The researchers report that these patients can safely return to routine non-invasive bowel cancer screening, avoiding unnecessary further colonoscopies.

Impact on guidelines and patient care

The findings strongly support the 2020 UK post-polypectomy surveillance guidelines, which recommend stopping surveillance in patients with low-risk findings at the first surveillance colonoscopy. However, the study challenges more conservative approaches in the current European post-polypectomy surveillance guidelines, which recommend that patients continue surveillance until they have two consecutive surveillance colonoscopies at which low-risk findings are detected.

Speaking about the findings,聽, Professor of Cancer Epidemiology and last author, said: 鈥淭hese findings could reduce the number of unnecessary colonoscopies, lessening the burden on healthcare systems and sparing patients from invasive procedures they may not need.鈥�

For patients, the study provides reassurance. Those with low-risk findings at their first surveillance colonoscopy, even if they had high-risk findings at their baseline colonoscopy, can be reassured that they are not at increased risk and can safely return to standard bowel cancer screening protocols.

Next steps

While the findings are promising, the authors note that the study鈥檚 ability to assess long-term surveillance needs in certain high-risk subgroups was limited by a small number of cancer cases. They suggest that future studies drawing on data from national screening programmes would help further refine recommendations.

The study not only supports current UK policy but offers a case for revisiting surveillance recommendations elsewhere in the world鈥攑otentially leading to a more evidence-based approach to bowel cancer prevention.