European Polyp Surveillance Trial Challenges Three-Year Colonoscopy Intervals
The findings suggest that the risk for colorectal cancer over the next 5 years may be low after removal of high-risk adenomas or serrated polyps. The European Polyp Surveillance (EPoS) project is the largest randomized trial to investigate surveillance of patients with colorectal polyps. It includes close to 21,000 patients across eight European countries. Michael Bretthauer, co-author and investigator on the trial, is a professor of medicine, Clinical Effectiveness Research Group, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Frequent Screening Creates Healthcare Costs and Patient Burden
Current guidelines recommend frequent surveillance with colonoscopies for patients with polyps, Bretthauer told Medscape Medical News. Due to widespread colorectal cancer screening, the number of people with polyps is increasing. The risk of colorectal cancer among patients with high-risk adenomas is lower than previous thought, according to Bretthauer. Data from the trial show that 99% did not develop colorectal cancer within 5 years after polyp removal.
Interim Analysis Evaluates Five-Year Versus Three-Year Intervals
The 5-year cumulative incidence of colorectal cancer was 0.77% vs 0.82% within the 5-year vs 3-year group.
Serrated Polyps Show Similar Low Risk Profiles at Five Years
All patients were assigned to have surveillance colonoscopy after 5 years and after 10 years. The 5-year incidence of colorectal cancer was 1.0% (95% CI, 0.2%-2.1%).
Experts Urge Caution Before Changing Colorectal Guidelines
The findings provide reassurance that a 5-year interval is reasonable for the endpoint of colorectal cancer, but she urged caution before incorporating the findings into guidelines. Schoen pointed to substantial noncompliance with the surveillance protocol and noted that while researchers used inverse probability weighting to adjust for noncompliance, there remains a risk of unmeasured confounding. Schoen is principal investigator of the US-based FORTE trial. Douglas Rex, Distinguished Professor Emeritus of Medicine and director of endoscopy at Indiana University School of Medicine in Indianapolis, noted the EPoS findings could be reasonably applied immediately. The US screening environment has a mixture of opportunistic screening and organized screening within integrated health systems. Age also remains an important unanswered question.
Frequently Asked Questions About EPoS Polyp Surveillance Findings
* What defines a high-risk adenoma in the EPoS II trial? The primary endpoint consists of the cumulative incidence of colorectal cancer at 10 years.
* Which organizations funded the EPoS studies?
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