To evaluate post-polypectomy surveillance practice in patients undergoing screening colonoscopy performed in the University of Szeged Gastroenterology Center between 2019 and 2022 furthermore, to examine its correlation with screening endoscopist adenoma detection rate.

In this retrospective single center observational cohort study, data regarding factors determining post-polypectomy surveillance timing (such as polyp number and size, histology subtype, grade of dysplasia) was obtained from the local hospital medical information system. Optimal surveillance timing was defined in the European Society of Gastrointestinal Endoscopy (ESGE) 2020 guideline update. The seven screening endoscopists were divided into three subgroups based on their adenoma detection rate (ADR) measured during the screening program.

Overall, 733 colonoscopies were evaluated (index N=607, 1st surveillance N=97, 2nd surveillance N=23, 3rd surveillance N=5, 4th surveillance N=1) with 35 to 80 months of follow-up period. Written recommendation regarding follow-up colonoscopy date was available in 306 cases (41.75%), moreover surveillance time was predominantly defined after acquiring information about histology results (N=254, 83.01%). Recommendation rate was the highest among the >40% ADR subgroup (56.95%) with optimal advice for surveillance given after 27.09% of colonoscopies. There was no significant difference between the subgroups in performing post-polypectomy surveillance colonoscopy with the optimal timing (<30% ADR: 36.69%, 30-40% ADR: 33.82%, >40% ADR: 42.90%). Either written recommendation or actual surveillance timing was adequate in 59.53% of cases, moreover “no surveillance/return to screening” strategy was used correctly in 88.24% of patients. Endoscopists with <30% ADR showed significantly lower adequacy for timing the follow-up colonoscopy (45.59%). Compared with the ESGE guideline, a different date was advised for surveillance in 86 patients, and all endoscopists encouraged earlier follow-up predominantly (N=65, 75.58%).

Choosing the adequate surveillance strategy after polypectomy is crucial to decrease the rate of interval colorectal cancer incidence, moreover, to reduce excess colonoscopy rate. Written recommendation regarding follow-up timing should be given either after colonoscopy, or when histology results are obtained, however the lack of advise given for surveillance in more than half of cases needs to be improved in the future. Endoscopists with higher ADR provided information about surveillance more frequently and more adequately. Post-polypectomy colonoscopy timing in practice demonstrated similar results in the ADR subgroups, yet endoscopists with >40% ADR scheduled surveillance the best.