Impact and patient benefits of Intermediate Adenomas and All Adenomas

It is possible that too many follow-up colonoscopies are being carried out, putting patients at risk, stretching healthcare workers and resulting in the NHS incurring potentially unnecessary costs.

These studies determine that colorectal cancer risk is no higher in some low- and intermediate-risk patients than in the general population. These patients likely do not need follow-up colonoscopy and could be managed by screening.

In the case of high-risk patients, who even after adenoma removal have a higher colorectal cancer risk than the general population, we determined that follow-up colonoscopies are necessary and cost-effective.

Scientific evidence for updating national surveillance guidelines

The study results contributed evidence to support the update of the post-polypectomy surveillance guidelines carried out in the UK for the British Society for Gastroenterology (BSG), The Association for Coloproctology of Great Britain and Ireland (ACPGBI) and the former Public Health England (PHE). These new guidelines were published in 2020 and were supported by high quality data from this study to make sure there is appropriate use of limited colonoscopy resources that will limit risks to patients and reduce costs for the NHS. It has been estimated that 80% fewer surveillance colonoscopies will be required under new guidelines.

Colorectal cancer risk evidence for adenoma patients

This study is the first to use colorectal cancer incidence as an outcome to evaluate post-polypectomy surveillance requirements. This study provides new, high-quality data on long-term colorectal cancer risk following adenoma removal. The large size of the cohort, longevity of follow-up, and contemporary data mean that the results generated will have enduring value as a referent for future interventions for minimising colorectal cancer risks in adenoma patients.

Ongoing analyses

Additional analyses of this data are ongoing, including investigations into mortality within each of the risk groups, and inflammatory bowel disease (IBD) and colorectal cancer risk.