Post-polypectomy follow-up after. removal of colorectal neoplasia
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1 Post-polypectomy follow-up after removal of colorectal neoplasia
2
3
4 Post-polypectomy endoscopic surveillance For each type of polyp BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance? 2. What is the efficacy of end. surveillance in reducing CRC risk? BURDEN 3. How many pts. present with this type of lesions?
5 1. Low-risk Group (LR-G) 1-2 tubular <10 mm adenoma(s) with LGD
6 Post-polypectomy endoscopic surveillance Low-risk Group (LR-G) BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance? vs. general population (CRC)
7 Life-time CRC risk: LR-G -LR-A cohort vs. general population -Case (CRC) vs. controls (no CRC) Adjusted OR 95% CI Brenner, JCO 2012
8 Life-time CRC risk: LR-G
9 Post-polypectomy endoscopic surveillance Low-risk Group (LR-G) BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance? vs. general population (CRC) vs. no-adenoma population (AN)
10 LR-A vs. no-a: Advanced Neoplasia incidence (11,387 pts.)
11 LR-A vs. no-a: Advanced Neoplasia incidence
12 LR-A vs. no-a: Advanced Neoplasia incidence
13 Post-polypectomy endoscopic surveillance Low-risk Group (LR-G) BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance? 2. What is the efficacy of end. surveillance in reducing CRC risk?
14 Efficacy of surveillance in LR-G CRC risk (%) LR/ES- LR/ES+
15 Efficacy of surveillance in LR-G >50% LR-ADR! >50% LR-ADR!
16 Post-polypectomy endoscopic surveillance Low-risk Group (LR-G) BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance? 2. What is the efficacy of end. surveillance in reducing CRC risk? BURDEN 3. How many pts. present with this type of lesions?
17 Prevalence of LR-G with HD
18 HR LR
19 Low-risk Group (LR-G) CRC risk Surveillance efficacy Convenient BURDEN Low/not increased No No High
20 Low-risk Group (LR-G)
21 1. Low-risk Group (LR-G) 1-2 tubular <10 mm adenoma(s) with LGD 2. High-risk Group (HR-G) >10 mm/villous/hgd or >3 adenoma(s)
22 Post-polypectomy endoscopic surveillance High-risk Group (HR-G) BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance?
23 Life-time CRC risk: HR-G -HR-A cohort vs. general population
24 Life-time CRC risk: LR-G
25 HR-G vs. LR-G:Advanced Neoplasia incidence
26 Post-polypectomy endoscopic surveillance High-risk Group (HR-G) BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance? 2. What is the efficacy of end. surveillance in reducing CRC risk?
27 Efficacy of surveillance in HR-G CRC risk (%) HR/ES- HR/ES+
28 Efficacy of surveillance in HR-G >50% LR-ADR! >50% LR-ADR!
29 Post-polypectomy endoscopic surveillance High-risk Group (HR-G) BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance? 2. What is the efficacy of end. surveillance in reducing CRC risk? BURDEN 3. How many pts. present with this type of lesions?
30 Prevalence of HR-G with HD
31 HR LR
32 High-risk Group (HR-G) CRC risk AN risk Surveillance efficacy Convenient BURDEN >50% LR-ADR! Increased Increased Yes Yes Small
33 High-risk Group (LR-G)
34 1. Low-risk Group (LR-G) 1-2 tubular <10 mm adenoma(s) with LGD 2. High-risk Group (HR-G) >10 mm/villous/hgd or >3 adenoma(s) 3. Serrated polyp (SP) Hyperplastic, serrated sessile, etc.
35 Post-polypectomy endoscopic surveillance Serrated polyp (SP) BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance? 2. What is the efficacy of end. surveillance in reducing CRC risk?
36 Serrated polyps Long-term CRC risk with SP unknown One small study suggested a higher risk of AN at surveillance in pts. with sessile serrated lesions Pts. with large or proximal sessile serrated lesions at higher risk of synchronous AN No evidence on efficacy of end. surveillance in pts. with SP
37 Post-polypectomy endoscopic surveillance Serrated polyp (SP) BENEFIT 1. What is the risk of CRC/Adv. Neo. (AN) w/out surveillance? 2. What is the efficacy of end. surveillance in reducing CRC risk? BURDEN 3. How many pts. present with this type of lesions?
38 Prevalence of LARGE SP
39 Serrated Polyps (SP) CRC risk AN risk Surveillance efficacy >50% LR-ADR! Uknown Increased (sinchronous) Uknown Convenient Uknown BURDEN Small
40 Sessile polyps (SP)
41
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