Balancing benefit and burden: rethinking post-polypectomy colonoscopy surveillance strategies

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Post-polypectomy colonoscopy surveillance is standard for reducing colorectal cancer (CRC) incidence and mortality.
• Concerns exist regarding the current balance of benefit, burden, and resource utilization in CRC surveillance strategies.
• Some patients classified as high-risk may have a low absolute CRC risk, potentially leading to overuse of surveillance.

Purpose of the Study:

• Critically examine limitations in current post-colonoscopy surveillance strategies.
• Advocate for a risk-stratified framework for CRC surveillance decisions.
• Propose optimizing surveillance intensity based on absolute CRC risk and patient factors.

Main Methods:

• Critical review of current post-polypectomy surveillance guidelines and practices.
• Analysis of limitations including data quality, risk misclassification, and resource allocation.
• Examination of the balance between CRC prevention benefits and patient/societal burdens.

Main Results:

• Current surveillance strategies may lead to suboptimal allocation of resources due to reliance on historical data and inadequate quality indicators.
• Insufficient focus on absolute colorectal cancer risk can result in patient misclassification and potentially unnecessary surveillance.
• The considerable burden of colonoscopy surveillance includes procedural risks, costs, and strain on endoscopy capacity.

Conclusions:

• A shift towards a comprehensive, risk-stratified framework is needed for post-polypectomy surveillance.
• Surveillance decisions should be guided by absolute colorectal cancer risk thresholds.
• Incorporating less invasive triage for lower-risk individuals can improve outcomes and minimize healthcare burden.