Extended surveillance intervals after colorectal ESD may be safe and feasible

Delayed surveillance colonoscopy (SC) did not lead to a significantly increased rate of metachronous advanced adenoma (MAA) among patients who had undergone R0 colorectal endoscopic submucosal dissection (ESD) for benign lesions.

“Post-polypectomy surveillance accounts for approximately 25% of the colonoscopies in adults over 50 years of age in Western countries,” according to Dr Paul Brouzeng (CHU Limoges, France) [1]. The research team aimed to evaluate the appropriateness of a delayed endoscopic follow-up in these patients. They performed a retrospective, multicentre, international study, including patients who underwent polypectomy for benign lesions, were followed up for at least 3 years, and had undergone at least 1 SC. The investigators compared 2 groups: an early SC (<24 months) followed by a late SC (>24 months; n=643), and a group that had only received a late SC (n=135).

The rate of advanced adenoma at the first SC was 3.9% in the ‘early group’ and 6.7% in the ‘late group’, representing a non-significant difference (P=0.167). 3 cases of colorectal cancer were detected, all in the ‘early group’. The investigators also assessed risk factors for metachronous advanced neoplasia and found that the number of non-large adenomas or serrated lesions at index colonoscopy was the only significant predictor (OR 1.16; 95% CI 1.07-1.27; P<0.01), whereas older age had a modestly protective effect (OR 0.97; P<0.05).

“The rate of advanced neoplasia following colorectal ESD for benign lesions is low, with no significant difference between early and late surveillance strategies,” concluded Dr Brouzeng. “Extending surveillance intervals may therefore be a safe option to reduce the colonoscopy burden, providing both economic and logistic benefits without compromising colorectal cancer prevention.”

1. Brouzeng P, et al. Safety and efficacy of extended surveillance intervals following colorectal ESD: an international multicentre study. LB12, Colorectal ESD: The better way? UEG Week, 4-7 October 2025, Berlin, Germany.

Medical writing support was provided by Robert van den Heuvel.
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Posted on 8 October 2025