A randomized trial published in the New England Journal of Medicine found that patients with high-risk adenomas may not need their first surveillance colonoscopy as soon as three years after polyp removal. In the interim analysis of the EPoS II trial, 10,799 patients across 49 endoscopy centers in eight European countries were randomized to begin surveillance at either 3 years or 5 years. At 5.5 years, colorectal cancer incidence was 0.77% in the 5-year group versus 0.82% in the 3-year group; the results met the study’s prespecified criteria for noninferiority.
The longer interval also substantially reduced the number of procedures: 4,434 colonoscopies were performed in the 5-year group compared with 8,614 in the 3-year group, a reduction of about 48.5%. CRC deaths were rare and similar between groups—three in the 5-year group and two in the 3-year group.
The authors note that current three-year surveillance recommendations are largely based on older observational evidence, while modern high-quality colonoscopy may have reduced the subsequent CRC risk after complete adenoma removal. However, this is only the 5-year interim analysis of a planned 10-year trial, and the final analysis is still needed.