Postpolypectomy surveillance for patients with MASLD may need to extend beyond determining when they should return for their next colonoscopy. A retrospective study of 2,331 patients with MASLD who had undergone adenoma removal found that those who reduced their cardiometabolic risk factors—including abdominal obesity, impaired fasting glucose, hypertension, hypertriglyceridemia and low HDL—had a significantly lower risk of developing metachronous advanced colorectal neoplasia. Any reduction in these risk factors was associated with a 51% lower risk, while the greatest benefit was seen among patients with the highest baseline metabolic burden and those who had advanced colorectal neoplasia at their initial colonoscopy. The findings raise an important question for GI practice: could the interval between surveillance colonoscopies become an opportunity for active metabolic risk reduction, rather than simply waiting for the next examination?
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