LAUSR

Introduction and aim Current British Society of Gastroenterology guidelines suggest patients who are deemed low risk after adenoma removal at colonoscopy (LNRC) should have no surveillance or colonoscopy interval of 5 years.1 However patients in the Bowel Screening Program (BCSP) who have LRNC are enrolled for subsequent faecal occult blood testing (FOBt) every 2 years. If test is positive, they are offered a further colonoscopy. Thus, it is possible that a BCSP patient who has LRNC can have up to 2 additional colonoscopies within the BCSP before the surveillance colonoscopy of a similar patient with LRNC, not in the BCSP who chose 5 year interval. AIM: To determine if or not surveillance colonoscopy <5 years from index LRNC led to intermediate or high risk neoplasia findings. Methods We identified all patients with previous LRNC in the North of Tyne screening centre from 2008–2010 who had attended for subsequent colonoscopy (episodes 2 and 3) because they had further positive FOBt. 2 authors (EC and HD) reviewed all endoscopy and histology reports to obtain patient details and identify presence of neoplasia and other pathologies. Colon neoplasia was deemed as low, intermediate or high risk according to BSG surveillance guidelines. Results 81 patients had colonoscopy (episode 2) for positive FOBt after LRNC. Full dataset was obtained for 78 (58% male). 10 of these had a 3rd colonoscopy (episode 3). Interval between episodes 1 and 2 was 2 years(yrs) in 86% and 4 years in 12%. Interval between episodes 2 and 3 was 2 years in 78%, 3 years in 11% and 4 years in 11%. The table below shows colonoscopy findings:Abstract PTU-051 Table 1 Episode No neoplasia Low risk ‘benign’ neoplasia Intermediate risk ‘benign’ neoplasia High risk neoplasia Cancer 2 57 13 6 1 1** 3 10 0 0 0 0 ** T3 (Dukes C) rectosigmoid cancer Conclusions Majority (90%) of patients who with positive FOBt after initial LRNC will not require further surveillance colonoscopy 9% of patients who have 2nd colonoscopy as FOBt pos. after LRNC will have neoplasia requiring further surveillance (i.e. become intermediate or high risk) In our cohort, colonoscopy in 1 patient with positive FOBt after previous LRNC identified a cancer Our data would support a recommendation that patients with positive FOBt with 2 previous LRNC’s within the BCSP should not be offered further colonoscopy within 5 years of their second procedure. Reference . Gut2010;59:666–690.