Yield of Advanced Neoplasia at Second Post-polypectomy Surveillance Colonoscopy: A Systematic Review and...

Individuals who have had polypectomy and at least one surveillance colonoscopy exam are routinely encountered, but evidence to inform risk for subsequent neoplasia and timing of surveillance is limited. Our aim was to conduct a systematic review and meta-analysis of serial surveillance yield.

We performed a systematic search of research literature databases through September 2024 and identified studies reporting neoplasia yield at baseline colonoscopy and at least 2 surveillance colonoscopies. Summary estimates of advanced neoplasia rates at second surveillance, according to baseline and first surveillance finding combinations (no adenoma, nonadvanced neoplasia, or advanced neoplasia) were pooled.

The pooled analysis included 5912 individuals from 11 observational studies. The proportion with advanced neoplasia at second surveillance among those with baseline no adenoma was 4% (95% confidence interval [CI], 2.5%-6.5%) after no adenoma, 7.2% (95% CI, 5.5%-9.4%) after nonadvanced neoplasia, and 11.4% (95% CI, 7.4%-17.2%) after advanced neoplasia at first surveillance, respectively. The proportion with advanced neoplasia at second surveillance among those with baseline nonadvanced neoplasia was 5.4% (95% CI, 3.7%-7.9%) after no adenoma, 9.1% (95% CI, 6.7%-12.3%) after nonadvanced neoplasia, and 20.2% (95% CI, 15.4%-25.9%) after advanced neoplasia at first surveillance, respectively. The proportion with advanced neoplasia at second surveillance among those with baseline advanced neoplasia was 9.1% (95% CI, 6.2%-13.0%) after no adenoma, 12.8% (95% CI, 9.5%-17.0%) after nonadvanced neoplasia, and 26.1% (95% CI, 18.4%-35.5%) after advanced neoplasia at first surveillance, respectively.

These findings support the concept of using results from both the baseline and first surveillance colonoscopies to provide a more accurate risk estimate than using results of only the most recent colonoscopy.