Two studies from the European Polyp Surveillance (EPoS) project suggest that extending post-polypectomy colonoscopy surveillance intervals may be safe for selected patients with high-risk adenomas or serrated polyps. The findings, published in The New England Journal of Medicine, come from one of the largest randomized investigations of colorectal polyp surveillance, involving nearly 21,000 patients across eight European countries.
In EPoS II, 10,799 patients with high-risk adenomas were randomized to surveillance colonoscopy at either three or five years. At five years, colorectal cancer incidence was similar between the groups: 0.77% in the five-year group versus 0.82% in the three-year group, meeting the study’s prespecified noninferiority criterion. More than 99% of participants remained free of CRC during this period.
A separate study, EPoS III, followed 1,861 patients with high-risk serrated polyps assigned to five-year surveillance. CRC incidence at five years was 1.0%. However, experts cautioned against immediately changing clinical practice, emphasizing the importance of high-quality baseline colonoscopy, patient risk profiles, and limitations related to surveillance noncompliance. US guideline changes are likely to depend on further review by the relevant societies.