P0360 - The Effectiveness of Post-Polypectomy Surveillance: Experiences in a Community-Based Setting

Julia J.. Liu, MD¹, Christina Guerrier, MBA², Dharini Chandrasekar, DO, MPH², Daniel Norez, MPH², Daniel Serie, MS², Daniel Hommes, MD, PhD², Nik Sheng Ding, MBBS, PhD^3
1Morehouse School of Medicine, Atlanta, GA; ²InterVenn Biosciences, South San Francisco, CA; ³St. Vincent’s Hospital, East Melbourne, Victoria, Australia

Introduction: Overuse of colonoscopy for colorectal cancer (CRC) post-polypectomy surveillance is a challenge in the US. A meta-analysis by Baile-Maxía et al. found that only individuals with a history of a polyp ≥2 cm or high-risk adenomas (any advanced adenomas (AAs) or ≥3 non-AAs) have high relative risks for metachronous CRC. We examined if post-polypectomy subjects present with higher risk polyps.

Methods: Subjects scheduled for colonoscopy across 12 US gastroenterology practices (NCT05445570) were enrolled. Redacted colonoscopy/pathology reports were obtained. Findings were grouped according to NCCN guidelines: clinical risk stratification (polyp-free colonoscopy, low risk polyps, high risk polyps), sizing ( >1cm, >2cm), and multiplicity ( >3, >5). Subjects were stratified into two groups: average risk and increased risk due to personal history of polyps/CRC (Table 1). The binomial test was used to assess if the proportion of subjects with average risk differed from the proportion of subjects with increased risk for each sample of colonoscopy findings.

Results: Of the 3,002 enrolled subjects, 2,476 had colonoscopies completed and reports were available at the time of data analysis; 70% of the subjects had good or excellent bowel prep. Cecal intubation was observed in 99% of colonoscopies, 65% of colonoscopies reported withdrawal times [93% with WT ≥ 6 minutes, 42% WT ≥ 9 minutes]. 1,946 subjects across two risk groups: average and increased (only subjects with personal history of polyps/CRC) were included. In the increased risk group, proper adherence to NCCN recommended surveillance was observed in 50%. 85% of non-adherent subjects had shorter than recommended intervals. Between the two groups there was no statistically significant difference in the proportion of subjects with high-risk polyps (p-values 0.99). There is no statistically significant difference between the proportion of subjects found to have a >1 cm or >2 cm polyp (p-values: 0.51, 0.39 respectively) or by multiplicity (p-values: 0.17 for >3; 0.51 for >5).

Discussion: In a real-world scenario of post-polypectomy surveillance, we observed excessive utilization of colonoscopy. In increased risk subjects, we did not observe a higher occurrence of high-risk lesions. Further studies will 1) assess whether the current interval recommendations for post-polypectomy surveillance are suitable, and 2) explore the feasibility of employing non-invasive testing methods to identify individuals at risk.



Disclosures:


Julia J.. Liu, MD¹, Christina Guerrier, MBA², Dharini Chandrasekar, DO, MPH², Daniel Norez, MPH², Daniel Serie, MS², Daniel Hommes, MD, PhD², Nik Sheng Ding, MBBS, PhD³. P0360 - The Effectiveness of Post-Polypectomy Surveillance: Experiences in a Community-Based Setting, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.