title: Impact of the consideration of serrated polyps to the interval of colonoscopic surveillance in the NHS Bowel Cancer Screening Programme.
abstract: OBJECTIVE
  Most international post polypectomy surveillance guidelines do not recommend surveillance for serrated polyps. In the present study the additional impact of serrated polyps on surveillance intervals from international adenoma surveillance guidelines was investigated.
  
  
  METHODS
  Endoscopic and pathology records were audited of participants in the NHS Bowel Cancer Screening Programme (guaiac faecal occult blood test, gFOBT) in 2011. Surveillance intervals were calculated for current guidelines and also for serrated polyps based on previously described aggressive and conservative strategies.
  
  
  RESULTS
  In total, 389 patients were included of whom 141 (36.2%) were high risk (advanced adenoma: adenoma ≥ 10 mm, villous elements, high grade dysplasia, or adenoma ≥ 3 in number) needing surveillance at ≤ 3 years. Thirty-three (8.5%) had significant serrated polyps, of whom 18 (4.6% of the total) had significant serrated lesions and simultaneous advanced adenoma or ≥ 3 adenomas. Adopting an aggressive surveillance strategy, the mean overall absolute additional proportion of all such patients in the surveillance group at 3 years or less was 4.0% (3.9% - 4.1%; 4.2% women; 3.8% men). These proportions varied according to endoscopist from 2.3% to 4.7%. For more conservative strategies the increase was only 1%.
  
  
  CONCLUSIONS
  The impact of including serrated polyps in current guidelines would result in a small increase in surveillance intervals for FOBT based bowel cancer screening. About half of those who might need surveillance for serrated polyps would already receive surveillance for being in a high risk adenoma group.
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK; Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Pullens
authors.forename: E
authors.initials: E
authors.lastname: Dekker
authors.forename: A J
authors.initials: AJ
authors.lastname: Ellis
authors.forename: R
authors.initials: R
authors.lastname: Guy
authors.forename: K
authors.initials: K
authors.lastname: Madronal
authors.forename: R
authors.initials: R
authors.lastname: Chetty
authors.forename: J E
authors.initials: JE
authors.lastname: East
mesh_terms: D018256:Adenomatous Polyps / Q000473:pathology*; D000368:Aged; D054869:Clinical Audit; D003111:Colonic Polyps / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods* / Q000592:standards; D015179:Colorectal Neoplasms / Q000473:pathology*; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013222:State Medicine; D013997:Time Factors; D006113:United Kingdom
keywords: Colonoscopy; colonic polyps; colorectal neoplasms; guidelines; healthcare costs